Provider Demographics
NPI:1437135530
Name:PULLIN, GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:PULLIN
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 1:4750 HEMPSTEAD STATION DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5164
Mailing Address - Country:US
Mailing Address - Phone:800-875-0136
Mailing Address - Fax:937-619-4342
Practice Address - Street 1:3200 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1227
Practice Address - Country:US
Practice Address - Phone:304-388-4170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17363207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0076738000Medicaid
VA010267714Medicaid
WV001718047OtherWV BCBS
WVP00307763OtherRAILROAD MEDICARE
WV001718047OtherBLUE CROSS BLUE SHIELD
WV930125094OtherCH1 RAILROAD MEDICARE
WV1053520OtherBRICKSTREET
WV1053520OtherWV DWC
WV930125095OtherCH2 RAILROAD MEDICARE
WVP00300482OtherPR1 RAILROAD MEDICARE
WV001718047OtherWV BCBS
WV1053520OtherWV DWC
WVP00307763OtherRAILROAD MEDICARE
WV930125095OtherCH2 RAILROAD MEDICARE
WV930125094OtherCH1 RAILROAD MEDICARE