Provider Demographics
NPI:1427149707
Name:PEARL, PAULA S (CRNP)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:S
Last Name:PEARL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 631568
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21263-1568
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6569 N CHARLES ST
Practice Address - Street 2:STE 205
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6831
Practice Address - Country:US
Practice Address - Phone:443-849-3051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR055125363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKJ31GB/708021-01OtherCAREFIRST MARYLAND
MDKJ44GB/708021-02OtherCAREFIRST OF MARYLAND
MDS124/0005OtherCAREFIRST REGIONAL
MD621061900Medicaid
MDS131/0002OtherCAREFIRST REGIONAL
S65492Medicare UPIN
MDS131/0002OtherCAREFIRST REGIONAL
MD621061900Medicaid
MD500005797Medicare PIN