1689653115 NPI number — DR. GARY LAWRENCE KULKA M.D.

Table of content: MELISSA R BARANELLO OT (NPI 1427347707)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689653115 NPI number — DR. GARY LAWRENCE KULKA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KULKA
Provider First Name:
GARY
Provider Middle Name:
LAWRENCE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KULKA
Provider Other First Name:
GARY
Provider Other Middle Name:
LARENCE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1689653115
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CMR 411 BOX 2988
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
09112-6337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-793-5620
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
US ARMY CLINIC
Provider Second Line Business Practice Location Address:
CMR 411
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-590-3902
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  0101237938 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1028812082 . This is a "DOD" identifier . This identifiers is of the category "OTHER".




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