Male or Other

Mr. Gary W. Watulak M.S.

Full Name

Mr. Gary Wayne Watulak M.S.

NPI Number

1952312373

NPI Type

Individual Provider

Gender

Male

Enumeration Date

08/10/2006

Specialties

(Taxonomies)

Code

103TC0700X
103TB0200X
103TC1900X
103TF0000X
103TP2701X
103T00000X

Primary Taxonomy

No
No
No
No
No
No

Licenses

State

Vermont

License Number

0470000240

Contact
Information

Purpose

Mailing
Location

Address

26 COTTAGE ST
26 COTTAGE ST

City

Rutland
Rutland

State

VT
VT

Postal Code

05701-3404
05701-3404

Country

US
US

Telephone Number

(802) 775-6031
(802) 775-6031

Identifiers

Identifier

51742
0006590
331856
11326073
691411
6590

Identifier State

Unknown
VT
VT
Unknown
VT
VT

Identifier Issuer

CIGNA
Unknown
MHN
CAQH
MVP
BCBS

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 07/08/2007

Provider Address