Provider Demographics
NPI:1356378640
Name:KULAS, PATRICIA M (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:KULAS
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 1:21785 FILIGREE CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-6214
Mailing Address - Country:US
Mailing Address - Phone:703-726-1201
Mailing Address - Fax:703-858-7150
Practice Address - Street 1:4001 FAIR RIDGE DR
Practice Address - Street 2:#103 FAIR OAKS IMAGING CENTER
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033
Practice Address - Country:US
Practice Address - Phone:703-385-5203
Practice Address - Fax:703-385-3058
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010543922085N0904X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00442435Medicare PIN
VA015178C19Medicare PIN