Provider Demographics
NPI:1952360513
Name:PEARSON, PHILIP Y (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:Y
Last Name:PEARSON
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 1:830 OLD LANCASTER RD
Mailing Address - Street 2:SUITE 306 MOB NORTH
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3118
Mailing Address - Country:US
Mailing Address - Phone:484-592-3000
Mailing Address - Fax:484-592-3009
Practice Address - Street 1:830 OLD LANCASTER RD
Practice Address - Street 2:SUITE 306 MOB NORTH
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3118
Practice Address - Country:US
Practice Address - Phone:484-592-3000
Practice Address - Fax:484-592-3009
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD068803L208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
I32628Medicare UPIN
PA10332660002Medicaid
I32628Medicare UPIN