Provider Demographics
NPI:1932275724
Name:BULLEN, RICARDO ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:ANTONIO
Last Name:BULLEN
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 1:2150 PENNSYLVANIA AVE NW
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-3201
Mailing Address - Country:US
Mailing Address - Phone:202-741-2618
Mailing Address - Fax:202-741-2609
Practice Address - Street 1:2150 PENNSYLVANIA AVE NW
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-3201
Practice Address - Country:US
Practice Address - Phone:202-741-2618
Practice Address - Fax:202-741-2609
Is Sole Proprietor?:No
Enumeration Date:2006-11-26
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75055207ND0101X, 207NS0135X, 207N00000X
DCMD037134207NS0135X, 207N00000X, 207ND0101X
CAA048415207NS0135X, 207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology