Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 36002316 | OH |
NPI | 1255327607 |
---|---|
Provider Name | Dr. Lee David Pearlman |
First Address | Gahanna, OH 43230-4573 |
Second Address | Columbus, OH 43231-6881 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2005 |
Last Update Date | 11/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0625274 | (05) | OH |
10797384 | CAQH (01) | OH |
T80710 | (02) | OH |