Provider Demographics
NPI:1932164878
Name:PERRY, RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
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 7402
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CAPE PORPOISE
Mailing Address - State:ME
Mailing Address - Zip Code:04014-7402
Mailing Address - Country:US
Mailing Address - Phone:207-468-4213
Mailing Address - Fax:207-468-4213
Practice Address - Street 1:72 MAIN ST
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-7021
Practice Address - Country:US
Practice Address - Phone:207-467-8909
Practice Address - Fax:207-467-8910
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME015363207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME038776OtherANTHEM
ME2365188OtherAETNA
MEM183508OtherCIGNA
MEMN3868OtherHARVARD PILGRIM
ME308430099Medicaid
MEM183508OtherCIGNA
MEP00748781Medicare PIN
D87306Medicare UPIN
ME308430099Medicaid