Provider Demographics
NPI:1548427651
Name:LULEY, TOMAS (DO)
Entity Type:Individual
Prefix:
First Name:TOMAS
Middle Name:
Last Name:LULEY
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:447 MCALISTER RD
Practice Address - Street 2:STE 3500
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-4114
Practice Address - Country:US
Practice Address - Phone:980-212-6230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-18
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-01179207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC2089Medicaid
NC2075005OtherMEDICARE PTAN, INDIVIDUAL
NC232009OtherMEDICARE GROUP PTAN
NC5912907Medicaid
NC1548427651Medicaid
NC1548427651Medicaid