Provider Demographics
NPI:1891011888
Name:PULVER, DEBORAH MOODY (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:MOODY
Last Name:PULVER
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 1:9122 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-2860
Mailing Address - Country:US
Mailing Address - Phone:215-331-1516
Mailing Address - Fax:215-331-8149
Practice Address - Street 1:9122 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-2860
Practice Address - Country:US
Practice Address - Phone:215-331-1516
Practice Address - Fax:215-331-8149
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD459922208000000X
NJ25MA09269000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics