Provider Demographics
NPI:1255697694
Name:PULICE, CHRISTINE ELLEN (DO)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ELLEN
Last Name:PULICE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 S GODDARD BLVD
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2931
Mailing Address - Country:US
Mailing Address - Phone:610-337-3232
Mailing Address - Fax:610-337-0325
Practice Address - Street 1:550 S GODDARD BLVD
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2931
Practice Address - Country:US
Practice Address - Phone:610-337-3232
Practice Address - Fax:610-337-0325
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAOS018181208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program