Provider Demographics
NPI:1437380292
Name:TULADHAR, BINOD (MD)
Entity Type:Individual
Prefix:
First Name:BINOD
Middle Name:
Last Name:TULADHAR
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 1:247 PROFESSIONAL WAY
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-4404
Mailing Address - Country:US
Mailing Address - Phone:360-426-3102
Mailing Address - Fax:
Practice Address - Street 1:1711 S STEPHENSON AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3639
Practice Address - Country:US
Practice Address - Phone:906-776-5800
Practice Address - Fax:906-776-5801
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60421294208000000X
IL125055394208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0220126OtherBCBS OF MI
MIB26002116Medicare PIN