Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | SC-004468-L | PA |
NPI | 1053400804 |
---|---|
Provider Name | Mrs. Cheralyn Suzanne Perkins |
First Address | Bangor, PA 18013-1526 |
Second Address | Bangor, PA 18013-1526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 15/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U84534 | (02) | PA |