Provider Demographics
NPI:1538255690
Name:ADAMS, PERRY MICHEAL (PA-C)
Entity type:Individual
Prefix:
First Name:PERRY
Middle Name:MICHEAL
Last Name:ADAMS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 WESLEY DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-7130
Mailing Address - Country:US
Mailing Address - Phone:410-912-7000
Mailing Address - Fax:410-912-4202
Practice Address - Street 1:1415 WESLEY DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-7130
Practice Address - Country:US
Practice Address - Phone:410-912-7000
Practice Address - Fax:410-912-4202
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0001363363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD430401200Medicaid