Provider Demographics
NPI:1043365927
Name:PEARSALL, AMY (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:PEARSALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 HARVARD ST
Mailing Address - Street 2:3
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2917
Mailing Address - Country:US
Mailing Address - Phone:646-483-8709
Mailing Address - Fax:
Practice Address - Street 1:344 HARVARD ST
Practice Address - Street 2:3
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-2917
Practice Address - Country:US
Practice Address - Phone:646-483-8709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA229863207Q00000X
MA239893207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine