Healthcare Provider Details

I. General information

NPI: 1124090444
Provider Name (Legal Business Name): MERRI BETH CULLY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4954 N PALMER RD BLDG 19
BETHESDA MD
20889-0004
US

IV. Provider business mailing address

4954 N PALMER RD BLDG 19
BETHESDA MD
20889-5600
US

V. Phone/Fax

Practice location:
  • Phone: 301-319-4435
  • Fax: 301-295-8280
Mailing address:
  • Phone: 619-851-3366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA17109
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: