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General NPI Number Information
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NPI Number | 1639792971
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Entity Type | Individual
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Provider Name | VICTORIA MORGAN BULLMAN MD
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Gender | Female
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Dates
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Enumeration Date | 05/21/2020
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Last Update Date | 08/25/2023
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Provider Practice Location Address
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Address Line | 4111 1ST AVE STE 2
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City | NITRO
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State | WV
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Zip | 25143-1345
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Country | US
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Telephone | 304-755-4797
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 MACCORKLE AVE SE
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City | CHARLESTON
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State | WV
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Zip | 25304-1227
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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 |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 32687
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License Number State | WV
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