Provider Demographics
NPI:1720046634
Name:GULLOTTO, CARMELO (MD)
Entity Type:Individual
Prefix:
First Name:CARMELO
Middle Name:
Last Name:GULLOTTO
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:PO BOX 19368
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27619-9368
Mailing Address - Country:US
Mailing Address - Phone:919-787-8221
Mailing Address - Fax:919-789-4461
Practice Address - Street 1:3949 BROWNING PL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6504
Practice Address - Country:US
Practice Address - Phone:919-787-8221
Practice Address - Fax:919-789-4461
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCD4955OtherMEDCOST
NC759869OtherCIGNA
NC891348NMedicaid
NCD5157OtherMEDCOST
NC1348NOtherBLUECROSS BLUESHIELD
NC3554449OtherAETNA
NC3573307OtherAETNA
NCP00166494OtherRAILROAD MEDICARE
NC3554448OtherAETNA
NCD5158OtherMEDCOST
NCP00226873OtherRAILROAD MEDICARE
NC20192260AMedicare ID - Type Unspecified
NCP00166494OtherRAILROAD MEDICARE
NCD5157OtherMEDCOST
NCD4955OtherMEDCOST