Provider Demographics
NPI:1588622088
Name:PEARLMAN, KEITH ELLIOT (MD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ELLIOT
Last Name:PEARLMAN
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 1:187 LAWRENCE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-0913
Mailing Address - Country:US
Mailing Address - Phone:917-518-4356
Mailing Address - Fax:
Practice Address - Street 1:187 LAWRENCE ST APT 1
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-0913
Practice Address - Country:US
Practice Address - Phone:917-518-4356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT807052084P0800X
NY215714390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty