Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 2016-02241 | NC |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 216990 | MA |
NPI | 1841289824 |
---|---|
Provider Name | Dr. Samantha Pulliam |
First Address | Boston, MA 02111-1552 |
Second Address | Chapel Hill, NC 27514 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2005 |
Last Update Date | 17/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2007002 | (05) | MA |
H89590 | (02) | MA |
J26321 | BLUE CROSS (01) |