Provider Demographics
NPI:1265460562
Name:PERLSWEIG, MARK STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
Last Name:PERLSWEIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 EL CAMINO REAL
Mailing Address - Street 2:SUITE 401
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3217
Mailing Address - Country:US
Mailing Address - Phone:650-692-2690
Mailing Address - Fax:650-692-2054
Practice Address - Street 1:1750 EL CAMINO REAL
Practice Address - Street 2:SUITE 401
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3217
Practice Address - Country:US
Practice Address - Phone:650-692-2690
Practice Address - Fax:650-692-2054
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG609962084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G609960Medicaid
CAE74528Medicare UPIN