MEDICARE: LULO UNIVERSITAS LIFE OBSERVATORY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	MD439432	PA

General Provider Information

NPI Number	:	1972932085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LULO UNIVERSITAS LIFE OBSERVATORY, LLC

Provider Business Mailing Address
First Line	:	PO BOX 397
Second Line	:
City	:	DALLASTOWN
State	:	PA
Zip	:	17313-0397
Country	:	US
Telephone Number	:	717-718-5786
Fax Number	:	717-718-5703

Provider Business Practice Location Address
First Line	:	25 N DUKE ST
Second Line	:	SUITE 207
City	:	YORK
State	:	PA
Zip	:	17401-1289
Country	:	US
Telephone Number	:	717-718-5786
Fax Number	:	717-718-5703

Authorized Official
Title or Position	:	MANAGER
Name	:	EDWARD LULO
Credential	:
Telephone Number	:	717-718-5786

Provider Enumeration Date	:	11/08/2013
Last Update Date	:	11/08/2013

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