Basic Information
Provider Information
NPI: 1578539078
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PERRY
FirstName: CYNTHIA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: BLANCHFIELD ARMY COMMUNITY HOSPITAL
Address2: 650 JOEL DRIVE
City: FT. CAMPBELL
State: KY
PostalCode: 422235349
CountryCode: US
TelephoneNumber: 2707988372
FaxNumber:  
Practice Location
Address1: BLANCHFIELD ARMY COMMUNITY HOSPITAL
Address2: 650 JOEL DRIVE
City: FT. CAMPBELL
State: KY
PostalCode: 422235349
CountryCode: US
TelephoneNumber: 2707988372
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/24/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2083P0901XJ0191TXY Allopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine

No ID Information.


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