Basic Information
| Provider Information | |||||||||
| NPI: | 1811951437 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PULLEY | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 820137 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191820137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102702352 | ||||||||
| FaxNumber: | 6102702358 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 POWELL ST | ||||||||
| Address2: | |||||||||
| City: | NORRISTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194013323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102702060 | ||||||||
| FaxNumber: | 6102702652 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | OS006613L | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1079942 | 01 | PA | KEYSTONE MERCY HP | OTHER | 0011527960006 | 05 | PA | MEDICAID | 0115279602 | 01 | PA | AMERICHOICE | OTHER | 6181287 | 01 | PA | CIGNA HMO/PPO | OTHER | 0502865000 | 01 | PA | PERSONAL CHOICE/KHPE | OTHER | 669753 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | OS006613L | 01 | PA | HEALTH PARTNERS | OTHER | 510687 | 01 | PA | PHCS | OTHER | 930055632 | 01 | PA | RRM | OTHER |