Basic Information
| Provider Information | |||||||||
| NPI: | 1457315954 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HULKA | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | FABIAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4102 N ROXBORO ST | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277042122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195952000 | ||||||||
| FaxNumber: | 9195952190 | ||||||||
| Practice Location | |||||||||
| Address1: | 4102 N ROXBORO ST | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277042122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195952000 | ||||||||
| FaxNumber: | 9195952190 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2006 | ||||||||
| LastUpdateDate: | 10/11/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 9400078 | NC | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 0404649 | 01 | NC | MAMSI | OTHER | 0404649 | 01 | NC | UHC | OTHER | 13557 | 01 | NC | PARTNERS | OTHER | 5854170 | 01 | NC | AETNA | OTHER | 8944233 | 05 | NC | MEDICAID | ENT37 | 01 | NC | PRIMAHEALTH | OTHER | 187964 | 01 | NC | MEDCOST | OTHER | 3455362 | 01 | NC | CIGNA | OTHER | 44233 | 01 | NC | BCBS NC | OTHER |