Provider Demographics
NPI:1972587905
Name:PULASKI, SHERRY L (MD)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:L
Last Name:PULASKI
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 1:3015 WILLIAMS DRIVE
Mailing Address - Street 2:STE 200
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4623
Mailing Address - Country:US
Mailing Address - Phone:703-641-9133
Mailing Address - Fax:703-280-5098
Practice Address - Street 1:10215 FERNWOOD RD
Practice Address - Street 2:STE 50
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817
Practice Address - Country:US
Practice Address - Phone:301-564-1053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC98006692085B0100X, 2085R0202X, 2085R0204X
MDD00236732085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
25336OtherPARTNERS
300130863OtherRR MEDICARE
WV3002923000Medicaid
81907OtherMEDCOST
7003032OtherAETNA
10691OtherBCBS
VA7208464Medicaid
NC7910691Medicaid
SCQ0066DMedicaid
7003032OtherAETNA
WV3002923000Medicaid
003366W85Medicare PIN