Provider Demographics
NPI:1568447779
Name:MICHAEL D PERILSTEIN, MD PC
Entity Type:Organization
Organization Name:MICHAEL D PERILSTEIN, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:PERILSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-327-2405
Mailing Address - Street 1:13 ARMAND HAMMER BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-5067
Mailing Address - Country:US
Mailing Address - Phone:610-327-2405
Mailing Address - Fax:610-327-8765
Practice Address - Street 1:13 ARMAND HAMMER BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-5067
Practice Address - Country:US
Practice Address - Phone:610-327-2405
Practice Address - Fax:610-327-8765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018220E207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA149463Medicare PIN