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NPI Code Detail

MEDICARE: RICHARD DOUGLAS ULSTAD PAC

MEDICARE: RICHARD DOUGLAS ULSTAD PAC
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
1363A00000XPhysician Assistant103634NC

General Provider Information

NPI Number : 1356304810
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD DOUGLAS ULSTAD PAC
Provider Business Mailing Address
First Line : 1905 GLEN MEADE RD
Second Line :
City : WILMINGTON
State : NC
Zip : 28403-6024
Country : US
Telephone Number : 910-763-6251
Fax Number : 910-763-7408
Provider Business Practice Location Address
First Line : 1905 GLEN MEADE RD
Second Line :
City : WILMINGTON
State : NC
Zip : 28403-6024
Country : US
Telephone Number : 910-763-6251
Fax Number : 910-763-7408
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2006
Last Update Date : 08/05/2014

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Directions to “ RICHARD DOUGLAS ULSTAD PAC” Practice Location

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