Provider Demographics
NPI:1871565341
Name:PERRY, JEFFREY N (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:N
Last Name:PERRY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4314 N. GEORGE ST. EXT'D
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:17345
Mailing Address - Country:US
Mailing Address - Phone:717-266-0252
Mailing Address - Fax:
Practice Address - Street 1:4314 N GEORGE STREET EXT
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:PA
Practice Address - Zip Code:17345-1307
Practice Address - Country:US
Practice Address - Phone:717-266-0252
Practice Address - Fax:717-266-6908
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010093L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01808034Medicaid
PA039846OtherGROUP PTAN
PA039846OtherGROUP PTAN
PAH20453Medicare UPIN
PA01808034Medicaid