Healthcare Provider Details

I. General information

NPI: 1356378640
Provider Name (Legal Business Name): PATRICIA M KULAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 FAIR RIDGE DR #103 FAIR OAKS IMAGING CENTER
FAIRFAX VA
22033
US

IV. Provider business mailing address

21785 FILIGREE CT SUITE 101
ASHBURN VA
20147-6214
US

V. Phone/Fax

Practice location:
  • Phone: 703-385-5203
  • Fax: 703-385-3058
Mailing address:
  • Phone: 703-726-1201
  • Fax: 703-858-7150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number0101054392
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101054392
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: