Provider Demographics
NPI:1245365717
Name:SUNDERLAND, PEARSON (MD)
Entity type:Individual
Prefix:DR
First Name:PEARSON
Middle Name:
Last Name:SUNDERLAND
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 1:4718 CUMBERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-5458
Mailing Address - Country:US
Mailing Address - Phone:301-654-0489
Mailing Address - Fax:301-654-1607
Practice Address - Street 1:4718 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-5458
Practice Address - Country:US
Practice Address - Phone:301-654-0489
Practice Address - Fax:301-654-1607
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD226622084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF64495Medicare UPIN
MDSU421327Medicare ID - Type Unspecified