MEDICARE: DR. KATHLEEN M. 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	207Q00000X	Family Medicine Physician	D0029301	MD

General Provider Information

NPI Number	:	1750395984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN M. TULLY M.D.

Provider Business Mailing Address
First Line	:	24 SOMERS CT
Second Line	:
City	:	COCKEYSVILLE
State	:	MD
Zip	:	21030-3007
Country	:	US
Telephone Number	:	410-952-3346
Fax Number	:

Provider Business Practice Location Address
First Line	:	16918 YORK RD
Second Line	:	SUITE 100
City	:	MONKTON
State	:	MD
Zip	:	21111-1022
Country	:	US
Telephone Number	:	410-357-5559
Fax Number	:	410-343-3008

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	07/08/2007

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