Provider Demographics
NPI:1447253695
Name:PEARLMAN, IRA HAYM (PHD)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:HAYM
Last Name:PEARLMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 COLLEY AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-1675
Mailing Address - Country:US
Mailing Address - Phone:757-625-5623
Mailing Address - Fax:757-627-1557
Practice Address - Street 1:1709 COLLEY AVE
Practice Address - Street 2:STE 202
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-1675
Practice Address - Country:US
Practice Address - Phone:757-625-5623
Practice Address - Fax:757-627-1557
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000975103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA018993OtherVALUE OPTIONS
VA080016OtherSENTARA BEH. HEALTH
VA066475OtherANTHEM BC/BS