MEDICARE: PAUL J ULICH MD

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	208600000X	Surgery Physician	0101043555	VA

General Provider Information

NPI Number	:	1396739314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL J ULICH MD

Provider Business Mailing Address
First Line	:	220 CAMPUS BLVD STE 100
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22601-2896
Country	:	US
Telephone Number	:	540-536-5100
Fax Number	:	540-536-0235

Provider Business Practice Location Address
First Line	:	190 CAMPUS BLVD STE 310
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22601-2872
Country	:	US
Telephone Number	:	540-536-0130
Fax Number	:	540-536-0140

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

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	06/10/2021

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