Provider Demographics
NPI:1851555015
Name:PEARL, LOUIS S (LIC AC)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:S
Last Name:PEARL
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 CRAWFORD ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2819
Mailing Address - Country:US
Mailing Address - Phone:508-655-1356
Mailing Address - Fax:
Practice Address - Street 1:6 W CENTRAL ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-4514
Practice Address - Country:US
Practice Address - Phone:508-655-1356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist