Provider Demographics
NPI:1437133204
Name:PERLMUTTER, MICHAEL LOREN (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LOREN
Last Name:PERLMUTTER
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 1:13 MATTHIAS LN
Mailing Address - Street 2:
Mailing Address - City:BARNSTABLE
Mailing Address - State:MA
Mailing Address - Zip Code:02630-1010
Mailing Address - Country:US
Mailing Address - Phone:202-441-1284
Mailing Address - Fax:508-362-3538
Practice Address - Street 1:13 MATTHIAS LN
Practice Address - Street 2:
Practice Address - City:BARNSTABLE
Practice Address - State:MA
Practice Address - Zip Code:02630-1010
Practice Address - Country:US
Practice Address - Phone:202-441-1284
Practice Address - Fax:508-362-3538
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD341252085R0202X
MDD00598042085R0202X
NY200324-12085R0202X
VAO1012341792085R0202X
WAMD000439732085R0202X
MA733042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
470001526OtherRR MEDICARE
P00031112OtherRR MEDICARE
MD405606000Medicaid
MD575P184HMedicare PIN
DC013931O31Medicare PIN
P00031112OtherRR MEDICARE
470001526OtherRR MEDICARE
G21524Medicare UPIN
DC013933W30Medicare PIN