Provider Demographics
NPI:1619017068
Name:PULASKI, JAMES PAUL (MD)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:PAUL
Last Name:PULASKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:204 BECKER DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-3134
Mailing Address - Country:US
Mailing Address - Phone:252-537-8193
Mailing Address - Fax:252-537-0589
Practice Address - Street 1:204 BECKER DR
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-3134
Practice Address - Country:US
Practice Address - Phone:252-537-8193
Practice Address - Fax:252-537-0589
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28986207W00000X
NC2007-01893207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G289860Medicaid
NC5910776Medicaid
CA00G289860Medicaid
A43929Medicare UPIN
NC2021961Medicare PIN