Healthcare Provider Details

I. General information

NPI: 1952536070
Provider Name (Legal Business Name): TANGELA ROCHELLE ANDERSON TULL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 10/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6610 TRIBUTARY ST SUITE 206
BALTIMORE MD
21224-6514
US

IV. Provider business mailing address

301 ST. PAUL PLACE MEDICAL STAFF OFFICE
BALTIMORE MD
21224-6514
US

V. Phone/Fax

Practice location:
  • Phone: 410-633-6300
  • Fax: 410-633-6736
Mailing address:
  • Phone: 410-659-2802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD0077741
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: