Healthcare Provider Details

I. General information

NPI: 1790954683
Provider Name (Legal Business Name): PAUL HENRY HULLETT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N GREENE ST OPERATING ROOM
BALTIMORE MD
21201-1524
US

IV. Provider business mailing address

10 N GREENE ST OPERATING ROOM
BALTIMORE MD
21201-1524
US

V. Phone/Fax

Practice location:
  • Phone: 410-605-7000
  • Fax: 410-605-7786
Mailing address:
  • Phone: 410-605-7000
  • Fax: 410-605-7786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR062969
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: