Provider Demographics
NPI:1780786038
Name:PERRY, SUSAN J (NP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:J
Last Name:PERRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 NEW BOSTON ROAD
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-5814
Mailing Address - Country:US
Mailing Address - Phone:508-679-0911
Mailing Address - Fax:508-536-0310
Practice Address - Street 1:373 NEW BOSTON ROAD
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5814
Practice Address - Country:US
Practice Address - Phone:508-679-0911
Practice Address - Fax:508-536-0310
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110333363LW0102X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP2308OtherBCBS
MA0321443Medicaid
MAP04292Medicare UPIN
MA0321443Medicaid