Provider Demographics
NPI:1386658359
Name:TRABULSI, LUTFI RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:LUTFI
Middle Name:RICHARD
Last Name:TRABULSI
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 1:1088 W BALTIMORE PIKE
Mailing Address - Street 2:SUITE 2302
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063
Mailing Address - Country:US
Mailing Address - Phone:610-565-6445
Mailing Address - Fax:610-565-6939
Practice Address - Street 1:1088 W BALTIMORE PIKE
Practice Address - Street 2:SUITE 2302
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063
Practice Address - Country:US
Practice Address - Phone:610-565-6445
Practice Address - Fax:610-565-6939
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD008315E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0030891000OtherBLUESHIELD/KEYSTONE
PA008395190002Medicaid
PA008395190002Medicaid
PAB34007Medicare UPIN