Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | R208134 | MD |
NPI | 1003420282 |
---|---|
Provider Name | Mrs. Mary Claire Perry |
First Address | Severna Park, MD 21146-4420 |
Second Address | Baltimore, MD 21201-1009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2020 |
Last Update Date | 03/09/2020 |