Provider Demographics
NPI:1447983937
Name:ULBRICH, MARK STEPHEN
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:STEPHEN
Last Name:ULBRICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 RAMSEY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25312-5609
Mailing Address - Country:US
Mailing Address - Phone:304-389-7730
Mailing Address - Fax:
Practice Address - Street 1:801 6TH ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-1612
Practice Address - Country:US
Practice Address - Phone:304-389-7730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-02
Last Update Date:2022-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist