Provider Demographics
NPI:1619082047
Name:PEARLMAN, DALE LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:LAWRENCE
Last Name:PEARLMAN
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 1:1220 UNIVERSITY DR
Mailing Address - Street 2:SUITE #203
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4265
Mailing Address - Country:US
Mailing Address - Phone:650-325-0505
Mailing Address - Fax:650-325-0932
Practice Address - Street 1:1220 UNIVERSITY DR
Practice Address - Street 2:SUITE #203
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4265
Practice Address - Country:US
Practice Address - Phone:650-325-0505
Practice Address - Fax:650-325-0932
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG030293207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G302930OtherBLUE CROSS
CA00G302930OtherBLUE SHIELD PROVIDER
CA00G302930Medicare PIN
CA00G302930OtherBLUE CROSS