Provider Demographics
NPI:1932890340
Name:MCCULLOUGH, ASHLEY THORNHILL
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:THORNHILL
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 LEONARD AVE BLDG 22ND
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-3368
Mailing Address - Country:US
Mailing Address - Phone:724-223-3100
Mailing Address - Fax:
Practice Address - Street 1:95 LEONARD AVE BLDG 22ND
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-3368
Practice Address - Country:US
Practice Address - Phone:724-223-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT227870207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine