=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457372872
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEVIN IRA PERMAN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2006
-----------------------------------------------------
Last Update Date | 10/16/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6420 ROCKLEDGE DR SUITE 4300
-----------------------------------------------------
City | BETHESDA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20817-7837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-571-0000
-----------------------------------------------------
Fax | 301-571-0853
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6420 ROCKLEDGE DR SUITE 4300
-----------------------------------------------------
City | BETHESDA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20817-7837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-571-0000
-----------------------------------------------------
Fax | 301-571-0853
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207WX0200X
-----------------------------------------------------
Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
-----------------------------------------------------
License Number | D0050928
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------