Provider Demographics
NPI:1225781917
Name:PERTMAN, JOSHUA ROSS (PA-C)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ROSS
Last Name:PERTMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BARONESS CT
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4505
Mailing Address - Country:US
Mailing Address - Phone:410-982-8773
Mailing Address - Fax:
Practice Address - Street 1:6821 REISTERSTOWN RD STE 106
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-1434
Practice Address - Country:US
Practice Address - Phone:410-358-6450
Practice Address - Fax:877-751-1761
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1192223363A00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty