Provider Demographics
NPI:1730146127
Name:MONTERO-PEARSON, PER M (MD)
Entity Type:Individual
Prefix:DR
First Name:PER
Middle Name:M
Last Name:MONTERO-PEARSON
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 1:1206 W SHERMAN AVE
Mailing Address - Street 2:BUILDING 1
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-6916
Mailing Address - Country:US
Mailing Address - Phone:856-462-6200
Mailing Address - Fax:856-462-6225
Practice Address - Street 1:1206 W SHERMAN AVE
Practice Address - Street 2:BUILDING 1
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6916
Practice Address - Country:US
Practice Address - Phone:856-462-6200
Practice Address - Fax:856-462-6225
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05567400208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2441501Medicaid
NJ664765Medicare ID - Type Unspecified
NJ2441501Medicaid