Provider Demographics
NPI:1205861564
Name:PEARLMAN, MICHAEL EDWARD (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EDWARD
Last Name:PEARLMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:EDWARD
Other - Last Name:PEARLMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM PA
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00351213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD255074OtherOPTIMUM CHOICE
480016925OtherRAILROAD RETIREMENT-MED
2701052OtherUNITED HEALTH CARE
MD602308800Medicaid
MD4621OtherBC
MDT085OtherBC
602308800OtherPRIORITY PARTNERS MCO
MDT30991Medicare UPIN
MD4621OtherBC
MDT085OtherBC