Healthcare Provider Details

I. General information

NPI: 1124081054
Provider Name (Legal Business Name): SUNITA V TULI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 01/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 ALFRED ST BALDWIN PARK II
WOBURN MA
01801-1976
US

IV. Provider business mailing address

7 ALFRED ST BALDWIN PARK II
WOBURN MA
01801-1976
US

V. Phone/Fax

Practice location:
  • Phone: 781-933-6236
  • Fax:
Mailing address:
  • Phone: 781-933-6236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number156878
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier201862
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerHARVARD COMMUNITY HEALTH
# 2
IdentifierJ19526
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBLUE CROSS BLUE SHIELD
# 3
Identifier0808513001
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerCIGNA
# 4
Identifier156878
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerTUFTS HEALTH PLAN
# 5
Identifier3184137
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: