Provider Demographics
NPI:1285633222
Name:MARCOTULLIO, SAMUEL G (DO)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:G
Last Name:MARCOTULLIO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15223-1954
Mailing Address - Country:US
Mailing Address - Phone:412-482-6800
Mailing Address - Fax:412-781-2123
Practice Address - Street 1:30 HIGH ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15223-1954
Practice Address - Country:US
Practice Address - Phone:412-482-6800
Practice Address - Fax:412-781-2123
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013369208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101346916Medicaid
PA93667Medicare PIN
PA101346916Medicaid