Healthcare Provider Details

I. General information

NPI: 1194793240
Provider Name (Legal Business Name): RAJESHREE TULLOO DIMKPA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RAJESHREE TULLOO M.D.

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 STATESVILLE BLVD
SALISBURY NC
28144-2316
US

IV. Provider business mailing address

PO BOX 1385
AHOSKIE NC
27910-1385
US

V. Phone/Fax

Practice location:
  • Phone: 704-637-1888
  • Fax: 704-637-1880
Mailing address:
  • Phone: 252-209-8161
  • Fax: 252-209-6011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number200501345
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number2005-01345
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: