Provider Demographics
NPI:1861802290
Name:ULTICARE
Entity type:Organization
Organization Name:ULTICARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:APOLLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-604-0568
Mailing Address - Street 1:11901 EVENING CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1252
Mailing Address - Country:US
Mailing Address - Phone:443-604-0568
Mailing Address - Fax:443-535-9704
Practice Address - Street 1:11901 EVENING CT
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-1252
Practice Address - Country:US
Practice Address - Phone:443-604-0568
Practice Address - Fax:443-535-9704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care