Provider Demographics
NPI:1336397009
Name:PULIDO, JONATHAN (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:PULIDO
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 1:2525 SOUTHEAST BLVD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-3464
Mailing Address - Country:US
Mailing Address - Phone:330-337-2868
Mailing Address - Fax:330-337-2875
Practice Address - Street 1:2094 E STATE ST
Practice Address - Street 2:SUITE A
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-4409
Practice Address - Country:US
Practice Address - Phone:330-337-2868
Practice Address - Fax:330-337-2875
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35095914208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0077366Medicaid
OH0077366Medicaid