Provider Demographics
NPI:1568416758
Name:TULLO, TERESA L (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:L
Last Name:TULLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1004
Mailing Address - Country:US
Mailing Address - Phone:336-584-5659
Mailing Address - Fax:336-584-4072
Practice Address - Street 1:1409 UNIVERSITY DR
Practice Address - Street 2:SUITE 105
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8776
Practice Address - Country:US
Practice Address - Phone:336-584-5659
Practice Address - Fax:336-584-4072
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200201320207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7761536OtherAETNA
NCP00187745OtherRAILROAD
NC136V2OtherBCBS
NC200157944OtherMEDCOST
NC136V2OtherBCBSNC
NC200157944OtherUNITED HEALTHCARE
NC89136V2Medicaid
NC199001OtherWELLPATH
NC200157944OtherTRICARE
NC89136V2Medicaid
NC2026686Medicare ID - Type Unspecified