MEDICARE: PATRICIA M KULAS M.D.

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	2085N0904X	Nuclear Radiology Physician	0101054392	VA
2	2085R0202X	Diagnostic Radiology Physician	0101054392	VA

General Provider Information

NPI Number	:	1356378640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA M KULAS M.D.

Provider Business Mailing Address
First Line	:	21785 FILIGREE CT
Second Line	:	SUITE 101
City	:	ASHBURN
State	:	VA
Zip	:	20147-6214
Country	:	US
Telephone Number	:	703-726-1201
Fax Number	:	703-858-7150

Provider Business Practice Location Address
First Line	:	4001 FAIR RIDGE DR
Second Line	:	#103 FAIR OAKS IMAGING CENTER
City	:	FAIRFAX
State	:	VA
Zip	:	22033
Country	:	US
Telephone Number	:	703-385-5203
Fax Number	:	703-385-3058

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

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	06/29/2010

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