=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568821379
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLINICAL RESEARCH GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2016
-----------------------------------------------------
Last Update Date | 02/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5160 POOKS HILL RD STE 7
-----------------------------------------------------
City | BETHESDA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20814-2070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-582-9300
-----------------------------------------------------
Fax | 888-863-6470
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5160 POOKS HILL RD STE 7
-----------------------------------------------------
City | BETHESDA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20814-2070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-582-9300
-----------------------------------------------------
Fax | 888-863-6470
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. JAMES R PERLSTROM
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 410-582-9300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 173F00000X
-----------------------------------------------------
Taxonomy Name | Sleep Specialist (PhD)
-----------------------------------------------------
License Number | 03368
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------