Provider Demographics
NPI:1437831435
Name:BULLUCK, ALBERT
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:BULLUCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 W BATTLEBORO AVENUE
Mailing Address - Street 2:
Mailing Address - City:BATTLEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27809
Mailing Address - Country:US
Mailing Address - Phone:252-907-4844
Mailing Address - Fax:
Practice Address - Street 1:221 W BATTLEBORO AVENUE
Practice Address - Street 2:
Practice Address - City:BATTLEBORO
Practice Address - State:NC
Practice Address - Zip Code:27809
Practice Address - Country:US
Practice Address - Phone:252-907-4844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver