Provider Demographics
NPI:1497712541
Name:BULA, WOLODYMYR IWAN (MD)
Entity Type:Individual
Prefix:DR
First Name:WOLODYMYR
Middle Name:IWAN
Last Name:BULA
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 2007
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-4507
Mailing Address - Country:US
Mailing Address - Phone:315-362-5285
Mailing Address - Fax:
Practice Address - Street 1:16 DEGRANDPRE WAY STE 600
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-6454
Practice Address - Country:US
Practice Address - Phone:518-563-0490
Practice Address - Fax:518-563-0707
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1966012085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01505384Medicaid
NY01505384Medicaid
F68408Medicare UPIN