Provider Demographics
NPI:1932105566
Name:PACHULSKI, ROMAN THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMAN
Middle Name:THOMAS
Last Name:PACHULSKI
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 1:33 LEWIS RD
Mailing Address - Street 2:2ND FL
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-5227
Mailing Address - Country:US
Mailing Address - Phone:607-729-8156
Mailing Address - Fax:
Practice Address - Street 1:30 HARRISON ST
Practice Address - Street 2:SUITE 250
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2161
Practice Address - Country:US
Practice Address - Phone:607-770-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9413207RC0001X
NY220668207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170134403Medicaid
TX8S9790OtherINDIVIDUAL BCBS #
TX0035MWOtherGROUP BCBS #
TX177066101Medicaid
TXF48435Medicare UPIN
TX00533ZMedicare ID - Type UnspecifiedGROUP MEDICARE #
TX177066101Medicaid