Provider Demographics
NPI:1578706917
Name:BULLERDICK, KERRY CAMDEN (MD)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:CAMDEN
Last Name:BULLERDICK
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 1:200 NASH MEDICAL ARTS MALL
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-1470
Mailing Address - Country:US
Mailing Address - Phone:252-443-5941
Mailing Address - Fax:
Practice Address - Street 1:200 NASH MEDICAL ARTS MALL
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804
Practice Address - Country:US
Practice Address - Phone:252-443-5941
Practice Address - Fax:252-443-5941
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-00868207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology