Provider Demographics
NPI:1679008767
Name:TULL, RECHELLE (MD)
Entity Type:Individual
Prefix:
First Name:RECHELLE
Middle Name:
Last Name:TULL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1330 OAK LN STE 101
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-2513
Mailing Address - Country:US
Mailing Address - Phone:434-847-6132
Mailing Address - Fax:434-845-4870
Practice Address - Street 1:1330 OAK LN STE 101
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24503-2513
Practice Address - Country:US
Practice Address - Phone:434-847-6132
Practice Address - Fax:434-845-4870
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101281328207ND0101X, 207N00000X
GA93485207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA93485OtherMEDICAL LICENSE