Provider Demographics
NPI:1376707935
Name:BULKLEY, MARIA GARCIA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:GARCIA
Last Name:BULKLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ACADEMY CIR
Mailing Address - Street 2:UNIT 110
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-5239
Mailing Address - Country:US
Mailing Address - Phone:267-639-4024
Mailing Address - Fax:
Practice Address - Street 1:3601 A ST
Practice Address - Street 2:SUITE 3308
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-1043
Practice Address - Country:US
Practice Address - Phone:215-427-4901
Practice Address - Fax:215-427-4385
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052871363A00000X
CT000556363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant