Provider Demographics
NPI:1720054778
Name:PERRY, ROGER RONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:RONALD
Last Name:PERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-8950
Mailing Address - Fax:757-446-5197
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 610
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-8950
Practice Address - Fax:757-446-5197
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044062208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA053790OtherANTHEM FF
VA15036OtherSENTARA
VAPAROtherMULTIPLAN
VAPAROtherUSA MANAGED CARE
NC0554MOtherBC/BS
VA215383OtherUHC/MAMSI
VA007327200Medicaid
VA307287OtherANTHEM PAC
VAPAROtherCIGNA
VAPAROtherAETNA
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
VA-019OtherTRICARE/CHAMPUS
NC890554MMedicaid
VAPAROtherVIRGINIA PREMIER HEALTH
VAPAROtherCORVEL/CORCARE
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherAETNA
VA020018112Medicare PIN
VA020000515Medicare PIN