Healthcare Provider Details

I. General information

NPI: 1336350552
Provider Name (Legal Business Name): STEVEN R. BULLARD, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2007
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2865 DUKE ST
ALEXANDRIA VA
22314-4512
US

IV. Provider business mailing address

2865 DUKE ST
ALEXANDRIA VA
22314-4512
US

V. Phone/Fax

Practice location:
  • Phone: 703-370-2455
  • Fax: 703-461-7887
Mailing address:
  • Phone: 703-370-2455
  • Fax: 703-461-7887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101052853
License Number StateVA

VIII. Authorized Official

Name: STEVEN REDDING BULLARD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 703-370-2455