Provider Demographics
NPI:1710419189
Name:PERLIN, KATHARINA ROSE (MD)
Entity Type:Individual
Prefix:
First Name:KATHARINA
Middle Name:ROSE
Last Name:PERLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RINA
Other - Middle Name:
Other - Last Name:PERLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4123 DUTCHMANS LN STE 503
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4730
Mailing Address - Country:US
Mailing Address - Phone:502-899-6220
Mailing Address - Fax:
Practice Address - Street 1:4123 DUTCHMANS LN STE 503
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4730
Practice Address - Country:US
Practice Address - Phone:502-899-6220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR51682084P0800X
IN01089982A2084P0800X
390200000X
KY581522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100836600Medicaid