Basic Information
| Provider Information | |||||||||
| NPI: | 1023070968 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PERRY | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | FAIRBANKS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 PERIMETER PARK DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | MORRISVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275608442 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6715 MCCRIMMON PKWY STE 300 | ||||||||
| Address2: | |||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275191916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194814997 | ||||||||
| FaxNumber: | 9193883271 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2006 | ||||||||
| LastUpdateDate: | 08/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 224904 | MA | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080A0000X | 224904 | MA | N | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine | 208000000X | 2012-02341 | NC | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.