Provider Demographics
NPI:1750590295
Name:PEARLETHA WASHINGTON, MD PC
Entity type:Organization
Organization Name:PEARLETHA WASHINGTON, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PEARLETHA
Authorized Official - Middle Name:ROZENIA
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-357-7667
Mailing Address - Street 1:148 E PEARCE BLVD
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-1511
Mailing Address - Country:US
Mailing Address - Phone:866-704-9765
Mailing Address - Fax:636-327-0058
Practice Address - Street 1:148 E PEARCE BLVD
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-1511
Practice Address - Country:US
Practice Address - Phone:866-704-9765
Practice Address - Fax:636-327-0058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD 108476207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty