Healthcare Provider Details

I. General information

NPI: 1932141447
Provider Name (Legal Business Name): PETER LULTSCHIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 LIBERTY ST
MEADVILLE PA
16335-2559
US

IV. Provider business mailing address

7 GLASSWORKS RD
GREENSBORO PA
15338-9507
US

V. Phone/Fax

Practice location:
  • Phone: 814-333-5000
  • Fax:
Mailing address:
  • Phone: 724-943-3308
  • Fax: 724-943-3310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberMD046576L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: