Provider Demographics
NPI:1437418274
Name:PEARSON, ELLEGANT S (MD)
Entity Type:Individual
Prefix:
First Name:ELLEGANT
Middle Name:S
Last Name:PEARSON
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 1:8116 GOOD LUCK RD
Mailing Address - Street 2:STE 300
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3508
Mailing Address - Country:US
Mailing Address - Phone:240-241-7474
Mailing Address - Fax:
Practice Address - Street 1:8116 GOOD LUCK RD
Practice Address - Street 2:STE 300
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3508
Practice Address - Country:US
Practice Address - Phone:240-241-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD80162207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine