Provider Demographics
NPI:1922005800
Name:PULICE, EDWARD A (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:A
Last Name:PULICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 MAIN ST FL 3
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-5363
Mailing Address - Country:US
Mailing Address - Phone:203-576-6500
Mailing Address - Fax:203-576-0035
Practice Address - Street 1:2720 MAIN ST FL 3
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-5363
Practice Address - Country:US
Practice Address - Phone:203-576-6500
Practice Address - Fax:203-576-0035
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT22265207W00000X
CT022265207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001222652Medicaid
CT180000244Medicare ID - Type Unspecified
CT1222653Medicaid