Healthcare Provider Details

I. General information

NPI: 1043598899
Provider Name (Legal Business Name): CHRISTINA LEE BULLEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2011
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7811 MONTROSE RD STE 340
POTOMAC MD
20854-3363
US

IV. Provider business mailing address

7811 MONTROSE RD STE 340
POTOMAC MD
20854-3363
US

V. Phone/Fax

Practice location:
  • Phone: 301-588-7888
  • Fax: 301-588-3419
Mailing address:
  • Phone: 301-588-7888
  • Fax: 301-588-3419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC06718
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberC06718
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: