Healthcare Provider Details

I. General information

NPI: 1518954700
Provider Name (Legal Business Name): ALLAN E WULC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 W GERMANTOWN PIKE STE 161
PLYMOUTH MEETING PA
19462-1062
US

IV. Provider business mailing address

610 W GERMANTOWN PIKE STE 161
PLYMOUTH MEETING PA
19462-1062
US

V. Phone/Fax

Practice location:
  • Phone: 610-828-8880
  • Fax: 610-828-8883
Mailing address:
  • Phone: 610-828-8880
  • Fax: 610-828-8883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD027087E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME57905
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number25MA05245800
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number14403
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG87419
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: