Provider Demographics
NPI:1497786131
Name:TABULOV, DEBORAH M (NP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:M
Last Name:TABULOV
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 SAVANNAH RD
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1675
Mailing Address - Country:US
Mailing Address - Phone:302-313-2298
Mailing Address - Fax:302-645-3691
Practice Address - Street 1:33664 BAYVIEW MEDICAL DR UNIT 2
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1687
Practice Address - Country:US
Practice Address - Phone:302-644-4954
Practice Address - Fax:302-645-5481
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR137151363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD062503500Medicaid
MDKR72G660Medicare ID - Type Unspecified
MD062503500Medicaid