Provider Demographics
NPI:1861408049
Name:PEARLMAN, FRED BARRY (DO)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:BARRY
Last Name:PEARLMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:488 LONGSPUR RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-3716
Mailing Address - Country:US
Mailing Address - Phone:440-446-0845
Mailing Address - Fax:216-227-1322
Practice Address - Street 1:14701 DETROIT AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4115
Practice Address - Country:US
Practice Address - Phone:216-227-1330
Practice Address - Fax:216-227-1322
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-004965208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F89036Medicare UPIN