MEDICARE: NATHAN CARR PULKINGHAM MD PA

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

General Provider Information

NPI Number	:	1952300998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATHAN CARR PULKINGHAM MD PA

Provider Business Mailing Address
First Line	:	PO BOX 3391
Second Line	:
City	:	MARTINSVILLE
State	:	VA
Zip	:	24115-3391
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1135 CARTHAGE ST
Second Line	:
City	:	SANFORD
State	:	NC
Zip	:	27330-4162
Country	:	US
Telephone Number	:	919-774-2270
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NATHAN C PULKINGHAM
Credential	:	MD
Telephone Number	:	919-774-2270

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	07/07/2008

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