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Provider Information for 1902983257

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PHILLIP PEARL MD

Gender: MALE

Individual NPI: 1902983257

Calendar   Last Updated:  2014-10-21
  Certification Date: 

Details

Name Value
NPI 1902983257
Enumeration Date 2006-11-01
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 300 LONGWOOD AVE NEUROLOGY - FEGAN 11
BOSTON, MA 02115-5724
United States

Phone: 617-355-6000 | Fax:
View Map External Link
Primary Practice Address 300 LONGWOOD AVE NEUROLOGY - FEGAN 11
BOSTON, MA 02115-5724
United States

Phone: 617-355-6000 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 2084N0402X - Psychiatry & Neurology Neurology with Special Qualifications in Child Neurology MA 71233
No 208000000X - Pediatrics MA 71233
No 2084N0600X - Psychiatry & Neurology Clinical Neurophysiology MA 71233
No 2084P0005X - Psychiatry & Neurology Neurodevelopmental Disabilities MA 71233