Healthcare Provider Details

I. General information

NPI: 1003884081
Provider Name (Legal Business Name): ALISAN G KULA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 LAKE MANASSAS DR
GAINESVILLE VA
20155-3257
US

IV. Provider business mailing address

7901 LAKE MANASSAS DR
GAINESVILLE VA
20155-3257
US

V. Phone/Fax

Practice location:
  • Phone: 571-222-2200
  • Fax: 571-222-2202
Mailing address:
  • Phone: 571-222-2200
  • Fax: 571-222-2202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number0101840419
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: