MEDICARE: ALEXIS DREW PULLARA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346722857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS DREW PULLARA

Provider Business Mailing Address
First Line	:	10514 RACETRACK RD
Second Line	:
City	:	BERLIN
State	:	MD
Zip	:	21811-3241
Country	:	US
Telephone Number	:	410-973-2301
Fax Number	:	410-973-2305

Provider Business Practice Location Address
First Line	:	420 E NORTH POINTE DR APT 460
Second Line	:
City	:	SALISBURY
State	:	MD
Zip	:	21804-2354
Country	:	US
Telephone Number	:	443-365-5077
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2018
Last Update Date	:	08/30/2018

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Directions to “ ALEXIS DREW PULLARA ” Practice Location

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