Provider Demographics
NPI:1427027440
Name:ULLMAN, DAVID ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:ULLMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5693 STATE HIGHWAY ROUTE 10 NORTH
Mailing Address - Street 2:PO BOX 648
Mailing Address - City:PALATINE BRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:13428-0648
Mailing Address - Country:US
Mailing Address - Phone:518-673-3722
Mailing Address - Fax:518-673-3196
Practice Address - Street 1:1300 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-1628
Practice Address - Country:US
Practice Address - Phone:518-268-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161907207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01140601Medicaid
NYE15715Medicare UPIN