Provider Demographics
NPI:1477712602
Name:BARBARA B ULLMAN
Entity Type:Organization
Organization Name:BARBARA B ULLMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ULLMAN
Authorized Official - Middle Name:BROWN
Authorized Official - Last Name:ULLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-782-0673
Mailing Address - Street 1:15 MONCKTON BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29206-4700
Mailing Address - Country:US
Mailing Address - Phone:803-782-0673
Mailing Address - Fax:803-782-0061
Practice Address - Street 1:15 MONCKTON BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29206-4700
Practice Address - Country:US
Practice Address - Phone:803-782-0673
Practice Address - Fax:803-782-0061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5053174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCB920030281Medicare UPIN