Individual
CAROL ULLOA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1000 E MOUNTAIN BLVD, WILKES BARRE, PA 18711-0027
(570) 808-6026
Mailing address
715 ALBANY ST, C 329, BOSTON, MA 02118-2526
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
224929
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10077692
EIN
MA
Enumeration date
04/23/2008
Last updated
01/30/2014
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