Provider Demographics
NPI:1700870722
Name:DORULLA, GEORGIA K (MD)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:K
Last Name:DORULLA
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 1:1500 ALBANY ST
Mailing Address - Street 2:SUITE 906
Mailing Address - City:BEECH GROVE
Mailing Address - State:IN
Mailing Address - Zip Code:46107-1557
Mailing Address - Country:US
Mailing Address - Phone:317-787-3296
Mailing Address - Fax:317-783-4107
Practice Address - Street 1:1500 ALBANY ST
Practice Address - Street 2:SUITE 906
Practice Address - City:BEECH GROVE
Practice Address - State:IN
Practice Address - Zip Code:46107-1557
Practice Address - Country:US
Practice Address - Phone:317-787-3296
Practice Address - Fax:317-783-4107
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10422982085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00032566OtherRAILROAD MEDICARE
P00408569OtherRAILROAD MEDICARE
P00033126OtherRAILROAD MEDICARE
P00033113OtherRAILROAD MEDICARE
P00033114OtherRAILROAD MEDICARE
P00032765OtherRAILROAD MEDICARE
P00033093OtherRAILROAD MEDICARE
IN000000109950OtherANTHEM
P00032884OtherRAILROAD MEDICARE
P00032561OtherRAILROAD MEDICARE
P00032996OtherRAILROAD MEDICARE
P00032995OtherRAILROAD MEDICARE
P00033075OtherRAILROAD MEDICARE
P00033114OtherRAILROAD MEDICARE
151700MMMedicare PIN
IN000000109950OtherANTHEM
P00033075OtherRAILROAD MEDICARE
P00032996OtherRAILROAD MEDICARE