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General NPI Number Information
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NPI Number | 1215957667
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Entity Type | Organization
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Legal Business Name | NATHAN CARR PULKINGHAM MD PA
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 09/10/2008
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Provider Practice Location Address
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Address Line | 1135 CARTHAGE ST
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City | SANFORD
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State | NC
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Zip | 27330-4162
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Country | US
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Telephone | 919-774-2270
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3391
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City | MARTINSVILLE
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State | VA
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Zip | 24115-3391
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. NATHAN C PULKINGHAM
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Credential | MD
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Telephone | 919-774-2270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 34D0963164
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License Number State | NC
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