Provider Demographics
NPI:1003884081
Name:KULA, ALISAN G (MD)
Entity Type:Individual
Prefix:
First Name:ALISAN
Middle Name:G
Last Name:KULA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7901 LAKE MANASSAS DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-3257
Mailing Address - Country:US
Mailing Address - Phone:571-222-2200
Mailing Address - Fax:571-222-2202
Practice Address - Street 1:7901 LAKE MANASSAS DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3257
Practice Address - Country:US
Practice Address - Phone:571-222-2200
Practice Address - Fax:571-222-2202
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101840419207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA223803OtherKAISER
VA316256-269606OtherMAMSI/OP CHOICE/ALLIANCE
VA500617-5975777OtherAETNA PPO
VA541795091OtherPHCS PPO/POS
VA284763OtherTRIGON/ANTHEM
VA3000041OtherUNITED HEALTHCARE
VA0870-0013OtherBCBS NCA/CARE FIRST
VA500617-2214436OtherAETNA HMO
VA541795091OtherFIRST HEALTH
VA1003884081Medicaid
VA504736OtherNCPPO
VA541795091OtherTRICARE
VA8522674001OtherCIGNA POS/PPO
VA8522674002OtherCIGNA HMO
VA541795091OtherFX CTY COMM HEALTH
VA541795091OtherPHCS PPO/POS
VA3000041OtherUNITED HEALTHCARE
VA500617-2214436OtherAETNA HMO
VA110188971Medicare PIN