Provider Demographics
NPI:1467540534
Name:PERLMUTTER, MARK NICHOLAS (MS,MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:NICHOLAS
Last Name:PERLMUTTER
Suffix:
Gender:M
Credentials:MS,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 PATRICK CT
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-1743
Mailing Address - Country:US
Mailing Address - Phone:252-443-0400
Mailing Address - Fax:252-443-0572
Practice Address - Street 1:110 PATRICK CT
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-1743
Practice Address - Country:US
Practice Address - Phone:252-443-0400
Practice Address - Fax:252-443-0572
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2015-00739207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE64770OtherUPIN
PA1189348Medicaid
PA1189348Medicaid
PA591623Medicare PIN