Provider Demographics
NPI:1114999497
Name:KULLICK, MARGARITA E (MD)
Entity Type:Individual
Prefix:
First Name:MARGARITA
Middle Name:E
Last Name:KULLICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARGARITA
Other - Middle Name:E
Other - Last Name:NAZDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1140 VARNUM STREET NE.
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2153
Mailing Address - Country:US
Mailing Address - Phone:202-832-7774
Mailing Address - Fax:202-526-0386
Practice Address - Street 1:1140 VARNUM STREET NE.
Practice Address - Street 2:SUITE 203
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2153
Practice Address - Country:US
Practice Address - Phone:202-832-7774
Practice Address - Fax:202-526-0386
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD13853174400000X, 207RN0300X
MDD24665174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC011740300Medicaid
DC0736691OtherAETNA
DCB94992OtherUPIN
MD4029313 00Medicaid
441250Medicare PIN
DC441250Medicare PIN
DC011740300Medicaid