Healthcare Provider Details

I. General information

NPI: 1235626904
Provider Name (Legal Business Name): CATHERINE VICTORIA KULICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-5127
US

IV. Provider business mailing address

3400 SPRUCE ST 3 W GATES
PHILADELPHIA PA
19104-4238
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-3606
  • Fax:
Mailing address:
  • Phone: 215-662-3606
  • Fax: 215-349-5579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License NumberMD476751
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD476751
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: