MEDICARE: DR. BETH ANNE ULRICH 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	208000000X	Pediatrics Physician	MD430838	PA
2	208000000X	Pediatrics Physician	2008-01021	NC

General Provider Information

NPI Number	:	1932231198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETH ANNE ULRICH M.D.

Provider Business Mailing Address
First Line	:	4019 VILLAGE PARK DR
Second Line	:
City	:	KNIGHTDALE
State	:	NC
Zip	:	27545-7044
Country	:	US
Telephone Number	:	919-266-5059
Fax Number	:	919-266-4309

Provider Business Practice Location Address
First Line	:	4019 VILLAGE PARK DR
Second Line	:
City	:	KNIGHTDALE
State	:	NC
Zip	:	27545-7044
Country	:	US
Telephone Number	:	919-266-5059
Fax Number	:	919-266-4309

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

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	03/02/2010

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