Provider Demographics
NPI:1457315954
Name:HULKA, GREGORY FABIAN (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:FABIAN
Last Name:HULKA
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 1:4102 N ROXBORO ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2122
Mailing Address - Country:US
Mailing Address - Phone:919-595-2000
Mailing Address - Fax:919-595-2190
Practice Address - Street 1:4102 N ROXBORO ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2122
Practice Address - Country:US
Practice Address - Phone:919-595-2000
Practice Address - Fax:919-595-2190
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400078207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0404649OtherMAMSI
NC0404649OtherUHC
NC13557OtherPARTNERS
NC5854170OtherAETNA
NC8944233Medicaid
NCENT37OtherPRIMAHEALTH
NC187964OtherMEDCOST
NC3455362OtherCIGNA
NC44233OtherBCBS NC
NC8944233Medicaid
NC5854170OtherAETNA
NCP00324128Medicare ID - Type UnspecifiedRAILROAD MEDICARE