Provider Demographics
NPI:1194759548
Name:PULVINO, JAMES QUEREAU (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:QUEREAU
Last Name:PULVINO
Suffix:
Gender:M
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:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3555 OLENTANGY RIVER RD.
Practice Address - Street 2:STE. 4050
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3921
Practice Address - Country:US
Practice Address - Phone:614-566-2727
Practice Address - Fax:614-566-2712
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35091711207V00000X
OH35.091711207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPENDINGMedicaid
OHPENDINGMedicare PIN