Provider Demographics
NPI:1629131347
Name:BULL, SHERMAN M (MD)
Entity Type:Individual
Prefix:
First Name:SHERMAN
Middle Name:M
Last Name:BULL
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 1:1351 WASHINGTON BLVD
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2419
Mailing Address - Country:US
Mailing Address - Phone:203-276-5959
Mailing Address - Fax:203-276-5969
Practice Address - Street 1:1351 WASHINGTON BLVD
Practice Address - Street 2:6TH FLOOR
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2419
Practice Address - Country:US
Practice Address - Phone:203-276-5959
Practice Address - Fax:203-276-5969
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT013695208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D03042Medicare UPIN