Basic Information
Provider Information
NPI: 1770505893
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TULIS
FirstName: MATTHEW
MiddleName: ROBERT
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 64374
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212644374
CountryCode: US
TelephoneNumber: 4103286331
FaxNumber: 4103281674
Practice Location
Address1: 22 S GREENE ST
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212011544
CountryCode: US
TelephoneNumber: 4103286331
FaxNumber: 4103281674
Other Information
ProviderEnumerationDate: 07/25/2006
LastUpdateDate: 01/22/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XD0074255MDY Allopathic & Osteopathic PhysiciansAnesthesiology 

ID Information
IDTypeStateIssuerDescription
33170130005MD MEDICAID


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