Provider Demographics
NPI:1225137201
Name:ULRICH, PHILLIP G (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:G
Last Name:ULRICH
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 1:30 BANK STREET
Mailing Address - Street 2:UNITED MEMORIAL MEDICAL CENTER CORPORATE HEALTH
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020
Mailing Address - Country:US
Mailing Address - Phone:585-344-4342
Mailing Address - Fax:585-344-5469
Practice Address - Street 1:30 BANK STREET
Practice Address - Street 2:UNITED MEMORIAL MEDICAL CENTER CORPORATE HEALTH
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020
Practice Address - Country:US
Practice Address - Phone:585-344-4342
Practice Address - Fax:585-344-5469
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162499207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD70111Medicare ID - Type Unspecified
E41739Medicare UPIN