Provider Demographics
NPI:1164589420
Name:GARY S. PERLMUTTER, M.D., P.C.
Entity Type:Organization
Organization Name:GARY S. PERLMUTTER, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:PERLMUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PC
Authorized Official - Phone:617-726-8656
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-2040
Mailing Address - Fax:
Practice Address - Street 1:1 HAWTHORNE PL
Practice Address - Street 2:SUITE 105
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2333
Practice Address - Country:US
Practice Address - Phone:617-726-8656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM17237OtherBLUE CROSS BLUE SHIELD MA