Individual
DR. CHARLES A. BULLABOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
601 CHILDRENS LN, NORFOLK, VA 23507-1910
(757) 668-7213
(757) 668-8225
Mailing address
PO BOX 79137, BALTIMORE, MD 21279-0137
(757) 668-7200
(757) 668-9691
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
0101058010
VA
2080P0202X
Pediatric Cardiology Physician
Primary
0101028010
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016948820001
—
PA
05
—
006722296
—
VA
05
—
0197625000
—
WV
05
—
119541700
—
MD
05
—
7905245
—
NC
Enumeration date
05/10/2006
Last updated
11/29/2012
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