Provider Demographics
NPI:1669678223
Name:PERNAR, LUISE INGEBORG MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:LUISE
Middle Name:INGEBORG MARIA
Last Name:PERNAR
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:720 HARRISON AVE
Mailing Address - Street 2:DOB 503
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:725 ALBANY STREET
Practice Address - Street 2:SHAPIRO 3 SUITE A
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-414-4861
Practice Address - Fax:617-414-3617
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA233239208600000X
MA239216208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery