Provider Demographics
NPI:1043349244
Name:TULLOCK, WILLIAM CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CHRISTOPHER
Last Name:TULLOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CASTLEBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:VENETIA
Mailing Address - State:PA
Mailing Address - Zip Code:15367-1389
Mailing Address - Country:US
Mailing Address - Phone:724-942-1310
Mailing Address - Fax:
Practice Address - Street 1:110 CASTLEBROOKE DR
Practice Address - Street 2:
Practice Address - City:VENETIA
Practice Address - State:PA
Practice Address - Zip Code:15367-1389
Practice Address - Country:US
Practice Address - Phone:724-942-1310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030529E204C00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB-38423Medicare UPIN