Provider Demographics
NPI:1518958941
Name:PULASKI, MARY E (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:PULASKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 MAMMOTH RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03109-4133
Mailing Address - Country:US
Mailing Address - Phone:603-663-8350
Mailing Address - Fax:603-663-8399
Practice Address - Street 1:275 MAMMOTH RD
Practice Address - Street 2:SUITE #1
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03109-4133
Practice Address - Country:US
Practice Address - Phone:603-663-8350
Practice Address - Fax:603-663-8399
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10661208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH259713OtherCIGNA PIN
NHNH1649OtherHPHC PIN
NH010661OtherTUFTS PIN
NH1240735OtherUHC PIN
NH2178405OtherAETNA PIN
NH30200270Medicaid
NH20048YOtherANTHEM REFERRING RAN
NHRE7570Medicare PIN
NH30200270Medicaid