Provider Demographics
NPI:1245276518
Name:PERILSTEIN, ERICA SUZANNE (MD)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:SUZANNE
Last Name:PERILSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:LIVERANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:531 W GERMANTOWN PIKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1325
Mailing Address - Country:US
Mailing Address - Phone:610-828-0400
Mailing Address - Fax:
Practice Address - Street 1:531 W GERMANTOWN PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1325
Practice Address - Country:US
Practice Address - Phone:610-828-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48452207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology