Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 0101262131 | VA |
N | 2080P0203X | Pediatric Critical Care Doctor | 0101262131 | VA |
NPI | 1033324488 |
---|---|
Provider Name | Michael A Mcculloch |
First Address | Charlottesville, VA 22906-9007 |
Second Address | Charlottesville, VA 22903-2824 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2007 |
Last Update Date | 05/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102117382 | (05) | PA |
4144660-00 | (05) | MD |