Provider Demographics
NPI:1962696419
Name:EARNEST PERRY, M.D., INC.
Entity type:Organization
Organization Name:EARNEST PERRY, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D. / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EARNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-744-0213
Mailing Address - Street 1:1320 BELMONT AVENUE
Mailing Address - Street 2:STE 2
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44501
Mailing Address - Country:US
Mailing Address - Phone:330-744-0213
Mailing Address - Fax:330-744-2101
Practice Address - Street 1:1320 BELMONT AVENUE
Practice Address - Street 2:STE 2
Practice Address - City:YOUNGSTONW
Practice Address - State:OH
Practice Address - Zip Code:44504
Practice Address - Country:US
Practice Address - Phone:330-744-0213
Practice Address - Fax:330-744-2101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH28596208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0108118Medicaid
OHA71153Medicare UPIN
OH0108118Medicaid