Healthcare Provider Details

I. General information

NPI: 1972587905
Provider Name (Legal Business Name): SHERRY L PULASKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10215 FERNWOOD RD STE 50
BETHESDA MD
20817
US

IV. Provider business mailing address

3015 WILLIAMS DRIVE STE 200
FAIRFAX VA
22031-4623
US

V. Phone/Fax

Practice location:
  • Phone: 301-564-1053
  • Fax:
Mailing address:
  • Phone: 703-641-9133
  • Fax: 703-280-5098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number9800669
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number9800669
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number9800669
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0023673
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: