Provider Demographics
NPI:1215118161
Name:MICHAEL E PEARLMAN D.P.M., P.A.
Entity type:Organization
Organization Name:MICHAEL E PEARLMAN D.P.M., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PEARLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-843-8058
Mailing Address - Street 1:12103 OLD LINE CTR
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2552
Mailing Address - Country:US
Mailing Address - Phone:301-843-8058
Mailing Address - Fax:301-932-8621
Practice Address - Street 1:12103 OLD LINE CTR
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2552
Practice Address - Country:US
Practice Address - Phone:301-843-8058
Practice Address - Fax:301-932-8621
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHAEL E PEARLMAN D.P.M., P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-20
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00351213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD255074OtherOPTIMUM CHOICE/MAMSI/ALLI
DC46210001OtherBC OF DC
MDT085OtherBC OF MARYLAND
DC46210001OtherBC OF DC
MD255074OtherOPTIMUM CHOICE/MAMSI/ALLI
MDT30991Medicare UPIN