Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 00648 | MD |
N | 213EP1101X | Primary Podiatric Medicine | PO368 | DC |
NPI | 1427184191 |
---|---|
Provider Name | Dr. Renee Carter-Perpall |
First Address | Bowie, MD 20718-2138 |
Second Address | Bowie, MD 20716-3133 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 27/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1125087 00 | (05) | MD |
146236 | MEDICARE PTAN (01) | |
T31205 | (02) | MD |