Healthcare Provider Details

I. General information

NPI: 1801076492
Provider Name (Legal Business Name): JOSHUA SHELTON HULL III PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2007
Last Update Date: 11/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9077 SHADY GROVE CT
GAITHERSBURG MD
20877-1301
US

IV. Provider business mailing address

14406 PECAN DR
ROCKVILLE MD
20853-2329
US

V. Phone/Fax

Practice location:
  • Phone: 301-977-0161
  • Fax: 301-460-5433
Mailing address:
  • Phone: 301-460-5433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number836
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: