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NPI Code Detail

MEDICARE: ZACHARY ANDREW WULBECKER

MEDICARE: ZACHARY ANDREW WULBECKER
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
1363A00000XPhysician AssistantPA.0003686CO
2363AM0700XMedical Physician Assistant1580NE
3363A00000XPhysician Assistant3497SC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P01212979OTHERCORAILROAD MEDICARE PIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1851698674
Entity Type Code : Individual
Provider Name (Legal Business Name) : ZACHARY ANDREW WULBECKER
Provider Business Mailing Address
First Line : PO BOX 118087
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29423-8087
Country : US
Telephone Number : 843-863-7462
Fax Number :
Provider Business Practice Location Address
First Line : 9200 UNIVERSITY BLVD
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29406-9121
Country : US
Telephone Number : 438-637-4628
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2011
Last Update Date : 08/31/2020

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Directions to “ ZACHARY ANDREW WULBECKER ” Practice Location

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