Provider Demographics
NPI:1700822814
Name:TULER, MARK (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:TULER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 SOUTH ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-3594
Mailing Address - Country:US
Mailing Address - Phone:781-893-8208
Mailing Address - Fax:
Practice Address - Street 1:32 SOUTH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-3594
Practice Address - Country:US
Practice Address - Phone:781-893-8208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1683213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9772715Medicaid
MA9772715Medicaid
MAT58747Medicare UPIN