Provider Demographics
NPI:1891003620
Name:TULACHAN, SIDHARTHA SINGH (MD)
Entity Type:Individual
Prefix:
First Name:SIDHARTHA
Middle Name:SINGH
Last Name:TULACHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 E. CLIFF DR. SUITE 1C
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4827
Mailing Address - Country:US
Mailing Address - Phone:915-351-7200
Mailing Address - Fax:915-351-7201
Practice Address - Street 1:1250 E. CLIFF DR. SUITE 1C
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4827
Practice Address - Country:US
Practice Address - Phone:915-351-7200
Practice Address - Fax:915-351-7201
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ8375207RG0100X
GA069911390200000X
OH57.017862390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX363753001Medicaid
TX363753001Medicaid