Provider Demographics
NPI:1194839969
Name:KULBERSH, DAVID L (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:KULBERSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WELLNESS BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2871
Mailing Address - Country:US
Mailing Address - Phone:803-732-4608
Mailing Address - Fax:803-732-4692
Practice Address - Street 1:1 WELLNESS BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2871
Practice Address - Country:US
Practice Address - Phone:803-732-4608
Practice Address - Fax:803-732-4692
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9733174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCB92988370Medicare UPIN