=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649566423
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINE MARIE ULLMAN D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2011
-----------------------------------------------------
Last Update Date | 12/11/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 118 MAIN STREET
-----------------------------------------------------
City | DUBLIN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24084-3211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-674-8805
-----------------------------------------------------
Fax | 540-674-8670
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 118 MAIN STREET
-----------------------------------------------------
City | DUBLIN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24084-3211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-674-8805
-----------------------------------------------------
Fax | 540-674-8670
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 0116023873
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 0102-203739
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------