Healthcare Provider Details

I. General information

NPI: 1386935559
Provider Name (Legal Business Name): TULASI GUDE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2011
Last Update Date: 12/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 S 9TH ST FL 1
PHILADELPHIA PA
19107-4408
US

IV. Provider business mailing address

25 S 9TH ST FL 1
PHILADELPHIA PA
19107-4408
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-1200
  • Fax: 215-923-6808
Mailing address:
  • Phone: 215-955-1200
  • Fax: 215-923-6808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD450235
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: