Individual
CHARLES MCCRORY PERME
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2201 LEXINGTON AVE, ASHLAND, KY 41101-2843
(606) 408-4000
(916) 533-0078
Mailing address
2754 SOLUTION CTR, CHICAGO, IL 60677-2007
(606) 864-9697
(916) 533-0078
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
35063920
OH
2085R0204X
Vascular & Interventional Radiology Physician
Primary
30415
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000038020
ANTHEM
OH
01
—
000000978917
ANTHEM BCBS
KY
05
—
0991066
—
OH
01
—
300094914
RAILROAD MEDICARE
OH
05
—
64937030
—
KY
Enumeration date
08/30/2006
Last updated
04/07/2016
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