Provider Demographics
NPI:1063469211
Name:COMPAAN, PEARL J (MD)
Entity Type:Individual
Prefix:
First Name:PEARL
Middle Name:J
Last Name:COMPAAN
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:PO BOX 10050
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90267-7550
Mailing Address - Country:US
Mailing Address - Phone:310-335-4056
Mailing Address - Fax:310-335-4098
Practice Address - Street 1:4415 AICHOLTZ RD STE 400B
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1506
Practice Address - Country:US
Practice Address - Phone:513-752-8100
Practice Address - Fax:512-752-8103
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350322052085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1287685Medicaid
OH4151271Medicare ID - Type UnspecifiedOPN MCARE
OH1287685Medicaid
OHA71457Medicare UPIN
OHCO4151272Medicare ID - Type UnspecifiedMIDDLETOWN MCARE