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General NPI Number Information
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NPI Number | 1255315479
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Entity Type | Individual
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Provider Name | EDWIN THOMAS PULASKI MD
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Gender | Male
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Dates
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Enumeration Date | 12/01/2005
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Last Update Date | 05/15/2008
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Provider Practice Location Address
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Address Line | 10215 FERNWOOD RD STE 50
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City | BETHESDA
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State | MD
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Zip | 20817
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Country | US
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Telephone | 301-564-1053
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Fax |
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Provider Business Mailing Address
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Address Line | 3015 WILLIAMS DRIVE STE 200
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City | FAIRFAX
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State | VA
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Zip | 22031-4623
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Country | US
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Telephone | 703-641-9133
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Fax | 703-280-5098
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number | 9601446
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 9601446
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 9601446
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | D0015047
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License Number State | MD
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