Provider Demographics
NPI:1912972431
Name:TULLOCH, MATTHEW J (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:J
Last Name:TULLOCH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:33663 BAYVIEW MEDICAL DR
Mailing Address - Street 2:UNIT 1
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1663
Mailing Address - Country:US
Mailing Address - Phone:302-645-3555
Mailing Address - Fax:302-644-3560
Practice Address - Street 1:18947 JOHN J WILLIAMS HWY
Practice Address - Street 2:SUITE 303
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-4474
Practice Address - Country:US
Practice Address - Phone:302-644-0690
Practice Address - Fax:302-644-0695
Is Sole Proprietor?:No
Enumeration Date:2006-02-19
Last Update Date:2014-09-11
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Provider Licenses
StateLicense IDTaxonomies
DEC10004560207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001150402Medicaid
DE0001150402Medicaid
DEG00693Medicare ID - Type UnspecifiedGROUP ID#