Provider Demographics
NPI:1457592107
Name:PERRY, IDA MARIE
Entity Type:Individual
Prefix:MRS
First Name:IDA
Middle Name:MARIE
Last Name:PERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CAPN LIJAHS RD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02632-1610
Mailing Address - Country:US
Mailing Address - Phone:508-771-5904
Mailing Address - Fax:
Practice Address - Street 1:4 CAPN LIJAHS RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02632-1610
Practice Address - Country:US
Practice Address - Phone:508-771-5904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health