1003884081 NPI number — ALISAN G KULA M.D.

Table of content: ALISAN G KULA M.D. (NPI 1003884081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003884081 NPI number — ALISAN G KULA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KULA
Provider First Name:
ALISAN
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

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 Information

NPI Number:
1003884081
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7901 LAKE MANASSAS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20155-3257
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-222-2200
Provider Business Mailing Address Fax Number:
571-222-2202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7901 LAKE MANASSAS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20155-3257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-222-2200
Provider Business Practice Location Address Fax Number:
571-222-2202
Provider Enumeration Date:
03/08/2006

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: 207RH0003X , with the licence number:  0101840419 , 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: 223803 . This is a "KAISER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 316256-269606 . This is a "MAMSI/OP CHOICE/ALLIANCE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 500617-5975777 . This is a "AETNA PPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 541795091 . This is a "PHCS PPO/POS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 284763 . This is a "TRIGON/ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 3000041 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0870-0013 . This is a "BCBS NCA/CARE FIRST" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 500617-2214436 . This is a "AETNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 541795091 . This is a "FIRST HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1003884081 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 504736 . This is a "NCPPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 541795091 . This is a "TRICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 8522674001 . This is a "CIGNA POS/PPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 8522674002 . This is a "CIGNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 541795091 . This is a "FX CTY COMM HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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