Provider Demographics
NPI:1811004567
Name:PERLMAN, STACIE ELAINE (MD)
Entity type:Individual
Prefix:DR
First Name:STACIE
Middle Name:ELAINE
Last Name:PERLMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 PLEASANT ST STE 205
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2548
Mailing Address - Country:US
Mailing Address - Phone:603-224-0584
Mailing Address - Fax:603-225-5769
Practice Address - Street 1:246 PLEASANT ST STE 205
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2548
Practice Address - Country:US
Practice Address - Phone:603-224-0584
Practice Address - Fax:603-225-5769
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA259236208600000X
NH18398208600000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COI58436Medicare UPIN
COP00421128Medicare PIN
MAS400164430Medicare PIN
COCO41268Medicare PIN
COC809292Medicare PIN
COCO41268Medicare PIN