Provider Demographics
NPI:1710965660
Name:PEARSON, FREDERICK NORMAN SR (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:NORMAN
Last Name:PEARSON
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9055 CHEVROLET DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-4016
Mailing Address - Country:US
Mailing Address - Phone:410-465-1515
Mailing Address - Fax:410-465-1839
Practice Address - Street 1:9055 CHEVROLET DR
Practice Address - Street 2:SUITE 204
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-4016
Practice Address - Country:US
Practice Address - Phone:410-465-1515
Practice Address - Fax:410-465-1839
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-01
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD02554207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6645Medicare ID - Type Unspecified
MDD74533Medicare UPIN
MDAX03Medicare PIN