MEDICARE: LEVI PEARSON III 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	207LP2900X	Pain Medicine (Anesthesiology) Physician	D0044512	MD
2	207L00000X	Anesthesiology Physician	D0044512	MD

General Provider Information

NPI Number	:	1780668152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEVI PEARSON III M.D.

Provider Business Mailing Address
First Line	:	9501 OLD ANNAPOLIS RD
Second Line	:	STE 305
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-6337
Country	:	US
Telephone Number	:	443-546-4969
Fax Number	:	443-546-4888

Provider Business Practice Location Address
First Line	:	9501 OLD ANNAPOLIS RD
Second Line	:	STE 305
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-6337
Country	:	US
Telephone Number	:	443-546-4969
Fax Number	:	443-546-4888

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	01/02/2020

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