Provider Demographics
NPI:1386662666
Name:BULLARD, EDWARD MICHAEL (RPA C)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:MICHAEL
Last Name:BULLARD
Suffix:
Gender:M
Credentials:RPA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2212 PENFIELD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-1756
Mailing Address - Country:US
Mailing Address - Phone:585-598-8555
Mailing Address - Fax:585-388-1483
Practice Address - Street 1:2212 PENFIELD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-1756
Practice Address - Country:US
Practice Address - Phone:585-598-8555
Practice Address - Fax:585-388-1483
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23008844363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02347611Medicaid
NY02347611Medicaid
NYPA2036Medicare PIN