Provider Demographics
NPI:1669836318
Name:PEARL, MATTHEW CRAIG (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CRAIG
Last Name:PEARL
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:STONY BROOK UNIVERSITY MEDICAL
Mailing Address - Street 2:HSC T-18
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8181
Mailing Address - Country:US
Mailing Address - Phone:631-444-1487
Mailing Address - Fax:631-444-3502
Practice Address - Street 1:16811 SOUTHWEST FWY STE 200
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-4728
Practice Address - Country:US
Practice Address - Phone:281-690-4678
Practice Address - Fax:281-565-8808
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXT8626207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program