Provider Demographics
NPI:1063560712
Name:PULEO, ELLEN ANNE (MD)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:ANNE
Last Name:PULEO
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 1:70 MEMORIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8707
Mailing Address - Country:US
Mailing Address - Phone:910-295-4342
Mailing Address - Fax:910-295-1165
Practice Address - Street 1:70 MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8707
Practice Address - Country:US
Practice Address - Phone:910-295-4342
Practice Address - Fax:910-295-1165
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25943207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8969462Medicaid
NCC81569Medicare UPIN
NC202931AMedicare PIN