1972587905 NPI number — SHERRY L PULASKI MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972587905 NPI number — SHERRY L PULASKI MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

PULASKI

Provider First Name:

SHERRY

Provider Middle Name:

L

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1972587905

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

05/15/2008

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

3015 WILLIAMS DRIVE

Provider Second Line Business Mailing Address:

STE 200

Provider Business Mailing Address City Name:

FAIRFAX

Provider Business Mailing Address State Name:

VA

Provider Business Mailing Address Postal Code:

22031-4623

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

703-641-9133

Provider Business Mailing Address Fax Number:

703-280-5098

Provider First Line Business Practice Location Address:

10215 FERNWOOD RD

Provider Second Line Business Practice Location Address:

STE 50

Provider Business Practice Location Address City Name:

BETHESDA

Provider Business Practice Location Address State Name:

MD

Provider Business Practice Location Address Postal Code:

20817

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

301-564-1053

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

12/02/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085B0100X , with the licence number:  9800669 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: 9800669 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0204X , with the licence number: 9800669 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: D0023673 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 25336 . This is a "PARTNERS" identifier . This identifiers is of the category "OTHER".
• Identifier: 300130863 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 3002923000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
• Identifier: 81907 . This is a "MEDCOST" identifier . This identifiers is of the category "OTHER".
• Identifier: 7003032 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 10691 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
• Identifier: 7208464 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
• Identifier: 7910691 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
• Identifier: Q0066D , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".