Provider Demographics
NPI:1891784203
Name:BARULICH, MATTHEW JOSEPH III (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOSEPH
Last Name:BARULICH
Suffix:III
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:PO BOX 2046
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702-2046
Mailing Address - Country:US
Mailing Address - Phone:775-882-8487
Mailing Address - Fax:775-882-8487
Practice Address - Street 1:2170 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-7026
Practice Address - Country:US
Practice Address - Phone:775-882-8487
Practice Address - Fax:775-882-8487
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5413207V00000X
CAA40451207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
160055464OtherMEDICARE RAILROAD
NV002013051Medicaid
160055464OtherMEDICARE RAILROAD
NVV35259Medicare PIN
NVC95765Medicare UPIN