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General NPI Number Information
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NPI Number | 1801985254
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Entity Type | Organization
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Legal Business Name | NICHOLAS F. CARULLI MD, PC
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 11/17/2009
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Provider Practice Location Address
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Address Line | 304 N LIESER RD
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City | VANCOUVER
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State | WA
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Zip | 98664-2115
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Country | US
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Telephone | 360-694-7565
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Fax | 360-906-0871
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Provider Business Mailing Address
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Address Line | PO BOX 8945
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City | VANCOUVER
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State | WA
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Zip | 98668-8945
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Country | US
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Telephone | 360-694-7565
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Fax | 360-906-0871
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NICHOLAS F CARULLI
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Credential | MD
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Telephone | 360-694-7565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD00037171
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License Number State | WA
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