Provider Demographics
NPI:1114983038
Name:GYNECOLOGIC ONCOLOGY ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:GYNECOLOGIC ONCOLOGY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:PULS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-455-5520
Mailing Address - Street 1:PO BOX 25277
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29616-0277
Mailing Address - Country:US
Mailing Address - Phone:864-455-5520
Mailing Address - Fax:864-455-1496
Practice Address - Street 1:900 W FARIS RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4255
Practice Address - Country:US
Practice Address - Phone:864-455-5520
Practice Address - Fax:864-455-1496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2020-08-22
Deactivation Date:2006-04-27
Deactivation Code:
Reactivation Date:2006-07-11
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Not Answered364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2449Medicaid
SCF81045Medicare UPIN
SC6185Medicare ID - Type Unspecified
SCGP2449Medicaid
SCS71015Medicare UPIN
SCH58992Medicare UPIN