Provider Demographics
NPI:1194793240
Name:DIMKPA, RAJESHREE TULLOO (MD)
Entity type:Individual
Prefix:
First Name:RAJESHREE
Middle Name:TULLOO
Last Name:DIMKPA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RAJESHREE
Other - Middle Name:
Other - Last Name:TULLOO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1385
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-1385
Mailing Address - Country:US
Mailing Address - Phone:252-209-8161
Mailing Address - Fax:252-209-6011
Practice Address - Street 1:310 STATESVILLE BLVD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2316
Practice Address - Country:US
Practice Address - Phone:704-637-1888
Practice Address - Fax:704-637-1880
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005013452084P0800X
NC2005-013452084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC182478OtherMEDCOST
NC5901639Medicaid
NC140F8OtherBCBS OF NC
NC140F8OtherBCBS OF NC
NC5901639Medicaid