Provider Demographics
NPI:1528189610
Name:MCCULLUM, NANCY NAYLOR (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:NAYLOR
Last Name:MCCULLUM
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 1:1050 WYNDWARD CT
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-4494
Mailing Address - Country:US
Mailing Address - Phone:717-848-2724
Mailing Address - Fax:717-741-9649
Practice Address - Street 1:205 ST. CHARLES WAY
Practice Address - Street 2:THE CENTER FOR COSMETIC DERMATOLOGY
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402
Practice Address - Country:US
Practice Address - Phone:717-741-5512
Practice Address - Fax:717-741-9649
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041481E170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1528189610OtherNPI