Provider Demographics
NPI:1609856020
Name:TULACRO, JAMES (PA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:TULACRO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 SUMMER ST
Mailing Address - Street 2:304
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5546
Mailing Address - Country:US
Mailing Address - Phone:203-325-5700
Mailing Address - Fax:203-325-8080
Practice Address - Street 1:999 SUMMER ST
Practice Address - Street 2:304
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5546
Practice Address - Country:US
Practice Address - Phone:203-325-5700
Practice Address - Fax:203-325-8080
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000947363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000947OtherSTATE LICENSE