Provider Demographics
NPI:1043311277
Name:PEARLMAN, JUSTIN D (MD ME PHD MA)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:D
Last Name:PEARLMAN
Suffix:
Gender:M
Credentials:MD ME PHD MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 GODDARD CIR
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7404
Mailing Address - Country:US
Mailing Address - Phone:617-894-6888
Mailing Address - Fax:
Practice Address - Street 1:25 GODDARD CIR
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7404
Practice Address - Country:US
Practice Address - Phone:617-894-6888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11571207RC0000X, 2085R0202X
MEMD21353207RC0000X
MA564662085R0202X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHD66147Medicare UPIN
MAD66147Medicare UPIN