Provider Demographics
NPI:1295738839
Name:KNULL, ALAN FRANKLIN (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:FRANKLIN
Last Name:KNULL
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 1:2400 LEE HWY N
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:VA
Mailing Address - Zip Code:24301-2326
Mailing Address - Country:US
Mailing Address - Phone:540-994-8483
Mailing Address - Fax:540-994-8392
Practice Address - Street 1:2400 LEE HWY N
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:VA
Practice Address - Zip Code:24301-2326
Practice Address - Country:US
Practice Address - Phone:540-994-8483
Practice Address - Fax:540-994-8392
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010368072085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010337542Medicaid
A80467Medicare UPIN
VAP00348537Medicare PIN
VA190001473Medicare PIN