MEDICARE: DR. RICHARD ULMER 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	207R00000X	Internal Medicine Physician	4594	SC

General Provider Information

NPI Number	:	1922185198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD ULMER MD

Provider Business Mailing Address
First Line	:	PO BOX 751649
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1649
Country	:	US
Telephone Number	:	843-789-1620
Fax Number	:	843-724-2440

Provider Business Practice Location Address
First Line	:	3510 HWY 17 NORTH
Second Line	:	SUITE 315
City	:	MT PLEASANT
State	:	SC
Zip	:	29466-8230
Country	:	US
Telephone Number	:	843-789-1830
Fax Number	:	843-971-1227

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	10/20/2015

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