MEDICARE: DR. DAVID BRADSHAW PEARLSTONE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	44328	CT
2	2086X0206X	Surgical Oncology Physician	44328	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	44328	OTHER	CT	CT LICENSE

General Provider Information

NPI Number	:	1962491878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID BRADSHAW PEARLSTONE M.D.

Provider Business Mailing Address
First Line	:	166 SPORT HILL RD
Second Line	:
City	:	EASTON
State	:	CT
Zip	:	06612-2203
Country	:	US
Telephone Number	:	203-913-0969
Fax Number	:

Provider Business Practice Location Address
First Line	:	166 SPORT HILL RD
Second Line	:
City	:	EASTON
State	:	CT
Zip	:	06612-2203
Country	:	US
Telephone Number	:	203-913-0969
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	02/03/2014

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