Provider Demographics
NPI:1114999497
Name:KULLICK, MARGARITA E (MD)
Entity type:Individual
Prefix:
First Name:MARGARITA
Middle Name:E
Last Name:KULLICK
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:MARGARITA
Other - Middle Name:E
Other - Last Name:NAZDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1001 ROCKVILLE PIKE APT 1613
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-6365
Mailing Address - Country:US
Mailing Address - Phone:301-675-7258
Mailing Address - Fax:
Practice Address - Street 1:1001 ROCKVILLE PIKE APT 1613
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-6365
Practice Address - Country:US
Practice Address - Phone:301-675-7258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD13853174400000X, 207RN0300X
MDD24665174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCB94992OtherUPIN
DC011740300Medicaid
DC0736691OtherAETNA
MD4029313 00Medicaid
441250Medicare PIN
DC441250Medicare PIN
DC011740300Medicaid