Provider Demographics
NPI:1265433833
Name:PERRY, MAURICE CLIVE (MD)
Entity type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:CLIVE
Last Name:PERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 4216
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17604-4216
Mailing Address - Country:US
Mailing Address - Phone:717-394-6028
Mailing Address - Fax:717-394-9223
Practice Address - Street 1:555 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2250
Practice Address - Country:US
Practice Address - Phone:717-394-6028
Practice Address - Fax:717-394-9223
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD064604L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001365081Medicaid
PA231855378OtherTAX ID - LANC RADIOLOGY
PA047809YYYOtherMEDICARE PTAN
PA300121888OtherRAILROAD MEDICARE
PA33-1011386OtherTAX ID - MRI GROUP, LLP
PA231855378OtherTAX ID - LANC RADIOLOGY
PA33-1011386OtherTAX ID - MRI GROUP, LLP