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General NPI Number Information
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NPI Number | 1881325504
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Entity Type | Individual
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Provider Name | ELLEN MARIA N/A BENITAH BULBARELLI M.D
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Gender | Female
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Dates
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Enumeration Date | 06/22/2022
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 150 CLEARWATER LARGO RD N STE 2
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City | LARGO
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State | FL
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Zip | 33770-2388
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Country | US
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Telephone | 727-518-0822
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Fax | 727-518-6511
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Provider Business Mailing Address
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Address Line | 150 CLEARWATER LARGO RD N STE 2
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City | LARGO
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State | FL
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Zip | 33770-2388
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Country | US
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Telephone | 727-518-0822
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Fax | 727-518-6511
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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 | MT225721
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License Number State | PA
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