Provider Demographics
NPI:1073502407
Name:STULC, JAROSLAV P (MD)
Entity Type:Individual
Prefix:
First Name:JAROSLAV
Middle Name:P
Last Name:STULC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-0468
Mailing Address - Country:US
Mailing Address - Phone:207-474-5121
Mailing Address - Fax:207-474-9261
Practice Address - Street 1:151 NORTH AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-2033
Practice Address - Country:US
Practice Address - Phone:207-474-7045
Practice Address - Fax:207-474-5173
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY28325208600000X
MEEL071025208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E47352Medicare UPIN