Provider Demographics
NPI:1316968639
Name:KULP DERMATOLOGY P.A.
Entity type:Organization
Organization Name:KULP DERMATOLOGY P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEEL
Authorized Official - Middle Name:DESAI
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-448-5145
Mailing Address - Street 1:130 PRESTON EXECUTIVE DR
Mailing Address - Street 2:STE 204
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8433
Mailing Address - Country:US
Mailing Address - Phone:919-388-9103
Mailing Address - Fax:919-388-9701
Practice Address - Street 1:130 PRESTON EXECUTIVE DR
Practice Address - Street 2:STE 204
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8433
Practice Address - Country:US
Practice Address - Phone:919-388-9103
Practice Address - Fax:919-388-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001403404174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC8081Medicare UPIN