Provider Demographics
NPI:1912930702
Name:PULLMAN-MOOAR, SALLY WARD (MD)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:WARD
Last Name:PULLMAN-MOOAR
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 1:2360 MARYLAND RD
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1709
Mailing Address - Country:US
Mailing Address - Phone:215-657-6776
Mailing Address - Fax:267-913-5963
Practice Address - Street 1:2360 MARYLAND RD
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1709
Practice Address - Country:US
Practice Address - Phone:215-657-6776
Practice Address - Fax:267-913-5963
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026335E207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA005478400OtherIBC
PA001060415Medicaid
B41949Medicare UPIN
PA001060415Medicaid