Provider Demographics
NPI:1699706994
Name:BULLINGA, JOHN R (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:BULLINGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:51 N 39TH STREET
Mailing Address - Street 2:4 PHI
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2640
Mailing Address - Country:US
Mailing Address - Phone:215-910-9044
Mailing Address - Fax:215-243-3264
Practice Address - Street 1:51 N 39TH STREET
Practice Address - Street 2:4 PHI
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-2640
Practice Address - Country:US
Practice Address - Phone:215-910-9044
Practice Address - Fax:215-243-3264
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD430155207RC0000X, 207RC0001X
CAA92426207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A924260Medicaid
CAWA92426DMedicare ID - Type Unspecified
CAI37075Medicare UPIN
CA00A924260Medicaid
PA116597L1CMedicare PIN