Provider Demographics
NPI:1780668152
Name:PEARSON, LEVI III (MD)
Entity Type:Individual
Prefix:
First Name:LEVI
Middle Name:
Last Name:PEARSON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:9501 OLD ANNAPOLIS RD
Mailing Address - Street 2:STE 305
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-6337
Mailing Address - Country:US
Mailing Address - Phone:443-546-4969
Mailing Address - Fax:443-546-4888
Practice Address - Street 1:9501 OLD ANNAPOLIS RD
Practice Address - Street 2:STE 305
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-6337
Practice Address - Country:US
Practice Address - Phone:443-546-4969
Practice Address - Fax:443-546-4888
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0044512207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF32001Medicare UPIN