Healthcare Provider Details

I. General information

NPI: 1578887212
Provider Name (Legal Business Name): TIMOTHY ANDREW PERL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

1645 LIBERTY RD STE 205
ELDERSBURG MD
21784-6542
US

V. Phone/Fax

Practice location:
  • Phone: 410-363-3242
  • Fax:
Mailing address:
  • Phone: 410-795-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP-640-793-067-993
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: