Provider Demographics
NPI:1457372872
Name:PERMAN, KEVIN IRA (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:IRA
Last Name:PERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6420 ROCKLEDGE DR
Mailing Address - Street 2:SUITE 4300
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-7837
Mailing Address - Country:US
Mailing Address - Phone:301-571-0000
Mailing Address - Fax:301-571-0853
Practice Address - Street 1:6420 ROCKLEDGE DR
Practice Address - Street 2:SUITE 4300
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-7837
Practice Address - Country:US
Practice Address - Phone:301-571-0000
Practice Address - Fax:301-571-0853
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050928207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00637551-1Medicaid
VA00637551-1Medicaid