MEDICARE: ELAINA LORD TULLY 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	208000000X	Pediatrics Physician	MD451461	PA
2	207R00000X	Internal Medicine Physician	MD451461	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588982409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELAINA LORD TULLY M.D.

Provider Business Mailing Address
First Line	:	1233 LOCUST ST FL 3
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5400
Country	:	US
Telephone Number	:	215-985-4448
Fax Number	:	215-732-1145

Provider Business Practice Location Address
First Line	:	1207 CHESTNUT ST FL 5
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4131
Country	:	US
Telephone Number	:	215-344-1632
Fax Number	:	215-564-8606

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

Provider Enumeration Date	:	05/17/2010
Last Update Date	:	03/17/2018

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