Provider Demographics
NPI:1689653115
Name:KULKA, GARY LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:LAWRENCE
Last Name:KULKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GARY
Other - Middle Name:LARENCE
Other - Last Name:KULKA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:CMR 411 BOX 2988
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:NY
Mailing Address - Zip Code:09112-6337
Mailing Address - Country:US
Mailing Address - Phone:202-793-5620
Mailing Address - Fax:
Practice Address - Street 1:US ARMY CLINIC
Practice Address - Street 2:CMR 411
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09112
Practice Address - Country:US
Practice Address - Phone:314-590-3902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237938207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1028812082OtherDOD