Provider Demographics
NPI:1417040528
Name:PULTE, ELIZABETH DIANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:DIANNE
Last Name:PULTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1015 CHESTNUT ST
Mailing Address - Street 2:SUITE 1321
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4310
Mailing Address - Country:US
Mailing Address - Phone:215-955-4730
Mailing Address - Fax:215-503-9188
Practice Address - Street 1:1015 CHESTNUT ST
Practice Address - Street 2:SUITE 1321
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4310
Practice Address - Country:US
Practice Address - Phone:215-955-4730
Practice Address - Fax:215-503-9188
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD442950207R00000X, 207RH0000X, 207RX0202X
NY213816207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102613907Medicaid
NJ0193054Medicaid
NJ0193054Medicaid
NJ145547Medicare PIN