Healthcare Provider Details

I. General information

NPI: 1033159017
Provider Name (Legal Business Name): JENNIFER LOUISE BULGER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 E 38TH ST
ERIE PA
16504-1559
US

IV. Provider business mailing address

RR 1 BOX 14
BEAR LAKE PA
16402-9602
US

V. Phone/Fax

Practice location:
  • Phone: 814-868-8661
  • Fax:
Mailing address:
  • Phone: 814-489-7984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberMD071008L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: