=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356378640
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICIA M KULAS M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2006
-----------------------------------------------------
Last Update Date | 06/29/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4001 FAIR RIDGE DR #103 FAIR OAKS IMAGING CENTER
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-385-5203
-----------------------------------------------------
Fax | 703-385-3058
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21785 FILIGREE CT SUITE 101
-----------------------------------------------------
City | ASHBURN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20147-6214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-726-1201
-----------------------------------------------------
Fax | 703-858-7150
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085N0904X
-----------------------------------------------------
Taxonomy Name | Nuclear Radiology Physician
-----------------------------------------------------
License Number | 0101054392
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 0101054392
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------