MEDICARE: MARK A TULECKE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZC0500X	Cytopathology Physician	11886	NH
2	207ZC0500X	Cytopathology Physician	155848	MA
3	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	11886	NH
4	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	155848	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	J23428	OTHER	MA	BCBS MA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	01Y004638NH01	OTHER	NH	BCBS NH
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356344527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK A TULECKE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 100519
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-0519
Country	:	US
Telephone Number	:	888-208-6228
Fax Number	:	603-778-1602

Provider Business Practice Location Address
First Line	:	1 HAMPTON RD
Second Line	:	UNIT 208
City	:	EXETER
State	:	NH
Zip	:	03833-4849
Country	:	US
Telephone Number	:	603-778-8522
Fax Number	:	603-778-1602

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	06/02/2008

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