Provider Demographics
NPI:1518954700
Name:WULC, ALLAN E (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:E
Last Name:WULC
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:610 W GERMANTOWN PIKE
Mailing Address - Street 2:STE 161
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1062
Mailing Address - Country:US
Mailing Address - Phone:610-828-8880
Mailing Address - Fax:610-828-8883
Practice Address - Street 1:610 W GERMANTOWN PIKE
Practice Address - Street 2:STE 161
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1062
Practice Address - Country:US
Practice Address - Phone:610-828-8880
Practice Address - Fax:610-828-8883
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2012-11-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD027087E208200000X
FLME57905208200000X
NJ25MA05245800208200000X
AZ14403208200000X
CAG87419208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
B41487Medicare UPIN
419208Medicare ID - Type Unspecified