1134126667 NPI number — RALPH J. TULLO, MD, PA

Table of content: (NPI 1134126667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134126667 NPI number — RALPH J. TULLO, MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RALPH J. TULLO, MD, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BREAST HEALTH INSTITUTE OF ORLANDO
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134126667
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 NORTH LAKE DESTINY ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAITLAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32751-4103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-699-6266
Provider Business Mailing Address Fax Number:
407-699-6266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 N LAKE DESTINY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAITLAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32751-4103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-699-6266
Provider Business Practice Location Address Fax Number:
407-699-6266
Provider Enumeration Date:
06/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TULLO
Authorized Official First Name:
ALICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR/BILLING COORDINATOR
Authorized Official Telephone Number:
407-699-6266

Provider Taxonomy Codes

  • Taxonomy code: 261QR0206X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 236228 . This is a "ACR FACILITY ID NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 5603 . This is a "MAITLAND OCCUPATIONAL LIC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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