Provider Demographics
NPI:1700867355
Name:PEARRE, ALBERT AUSTIN JR (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:AUSTIN
Last Name:PEARRE
Suffix:JR
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 1:300 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4541
Mailing Address - Country:US
Mailing Address - Phone:301-662-8119
Mailing Address - Fax:301-696-0985
Practice Address - Street 1:300 W 9TH ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4541
Practice Address - Country:US
Practice Address - Phone:301-662-8119
Practice Address - Fax:301-696-0985
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0009689174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD008621500Medicaid
MD1700867355OtherMEDICAID NPI
MD110047908OtherMEDICARE RAILROAD
MD008621500Medicaid
MD110047908OtherMEDICARE RAILROAD