Provider Demographics
NPI:1134126667
Name:RALPH J. TULLO, MD, PA
Entity Type:Organization
Organization Name:RALPH J. TULLO, MD, PA
Other - Org Name:BREAST HEALTH INSTITUTE OF ORLANDO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR/BILLING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TULLO
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, CMSR
Authorized Official - Phone:407-699-6266
Mailing Address - Street 1:300 NORTH LAKE DESTINY ROAD
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4103
Mailing Address - Country:US
Mailing Address - Phone:407-699-6266
Mailing Address - Fax:407-699-6266
Practice Address - Street 1:300 N LAKE DESTINY RD
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4103
Practice Address - Country:US
Practice Address - Phone:407-699-6266
Practice Address - Fax:407-699-6266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL236228OtherACR FACILITY ID NUMBER
FL5603OtherMAITLAND OCCUPATIONAL LIC
FL236228OtherACR FACILITY ID NUMBER