Active NPI
Charles A. Bullaboy, M.D.
- Pediatric Cardiology Physician
- Norfolk, VA
National Provider Identifier
1699724245
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Cardiology Physician
- License
- 0101028010
- Practice address
- 601 Childrens LN
Norfolk, VA 23507-1910 - Phone
- (757) 668-7213
- Fax
- (757) 668-8225
- NPI assigned
- May 10, 2006
- Last updated
- Nov 29, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 0101058010 | VA | |
| Pediatric Cardiology Physician | 2080P0202X | 0101028010 | VA | Primary |
Addresses
Primary practice location
601 Childrens LN
Norfolk, VA 23507-1910
Mailing address
PO Box 79137
Baltimore, MD 21279-0137
Phone (757) 668-7200
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0016948820001 | Medicaid | PA | |
| 7905245 | Medicaid | NC | |
| 006722296 | Medicaid | VA | |
| 119541700 | Medicaid | MD | |
| 0197625000 | Medicaid | WV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0101058010 | VA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1354147200000",
"number": "1699724245",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 79137",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212790137",
"telephone_number": "757-668-7200",
"fax_number": "757-668-9691"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "601 CHILDRENS LN",
"city": "NORFOLK",
"state": "VA",
"postal_code": "235071910",
"telephone_number": "757-668-7213",
"fax_number": "757-668-8225"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BULLABOY",
"first_name": "CHARLES",
"middle_name": "A.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-10",
"last_updated": "2012-11-29",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "VA",
"license": "0101058010",
"primary": false
},
{
"code": "2080P0202X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Cardiology",
"state": "VA",
"license": "0101028010",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0016948820001",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7905245",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "006722296",
"state": "VA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "119541700",
"state": "MD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0197625000",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Norfolk, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.