Healthcare Provider Details

I. General information

NPI: 1841289824
Provider Name (Legal Business Name): SAMANTHA PULLIAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 05/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DRIVE UNC HOSPITALS
CHAPEL HILL NC
27514
US

IV. Provider business mailing address

800 WASHINGTON ST
BOSTON MA
02111-1552
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-4717
  • Fax: 984-974-0499
Mailing address:
  • Phone: 617-636-5000
  • Fax: 617-636-1465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number2016-02241
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number216990
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: