Healthcare Provider Details

I. General information

NPI: 1912094962
Provider Name (Legal Business Name): TULLIKA GARG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NORTH ACADEMY AVE.
DANVILLE PA
17822-1316
US

IV. Provider business mailing address

100 NORTH ACADEMY AVE.
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-271-6328
  • Fax: 570-271-6955
Mailing address:
  • Phone: 570-271-6328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberBG9954252
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD451882
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: