Provider Demographics
NPI:1366438608
Name:PERRY, JEAN MARIE (PAC)
Entity type:Individual
Prefix:MS
First Name:JEAN MARIE
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 CURRY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-4621
Mailing Address - Country:US
Mailing Address - Phone:412-653-4900
Mailing Address - Fax:412-653-9969
Practice Address - Street 1:330 CURRY HOLLOW RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236-4621
Practice Address - Country:US
Practice Address - Phone:412-653-4900
Practice Address - Fax:412-653-9969
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000672L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S47919Medicare UPIN