Provider Demographics
NPI:1437138187
Name:ULMER, JOHN D (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:ULMER
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:PO BOX 890580
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-0580
Mailing Address - Country:US
Mailing Address - Phone:540-427-4406
Mailing Address - Fax:540-427-4915
Practice Address - Street 1:78 MEDICAL CENTER DR
Practice Address - Street 2:AUGUSTA MEDICAL CENTER, ANESTHESIA DEPARTMENT
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2332
Practice Address - Country:US
Practice Address - Phone:540-427-4406
Practice Address - Fax:540-427-4915
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238447207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010414806Medicaid
VAF83878Medicare UPIN
VA012037A90Medicare PIN