Provider Demographics
NPI:1619037553
Name:PERLMAN, BRUCE STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:STEPHEN
Last Name:PERLMAN
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 1:1 INDEPENDENCE PT STE 212
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4536
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1809 WADE HAMPTON BLVD STE 120
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-4050
Practice Address - Country:US
Practice Address - Phone:864-522-5000
Practice Address - Fax:864-241-9275
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200901561207R00000X, 208M00000X
SC30985207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5911003Medicaid
SC309856Medicaid
NCP00958831OtherRR MEDICARE
GA963178-09859OtherBLUE CROSS BLUE SHIELD
GA000409934BMedicaid
GA963178-09859OtherBLUE CROSS BLUE SHIELD
NC5911003Medicaid
NC5911003Medicaid
GA000409934BMedicaid
NC2076513Medicare PIN