Provider Demographics
NPI:1215144506
Name:TULLY, AMBER STONEHOUSE (MD)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:STONEHOUSE
Last Name:TULLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMBER
Other - Middle Name:RAE
Other - Last Name:STONEHOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:19324 DETROIT RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-1802
Mailing Address - Country:US
Mailing Address - Phone:440-356-3640
Mailing Address - Fax:440-356-3729
Practice Address - Street 1:19324 DETROIT RD
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-1802
Practice Address - Country:US
Practice Address - Phone:440-356-3640
Practice Address - Fax:440-356-3729
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2014-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH097948207Q00000X
PAMD433078207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0053862Medicaid
NJ0178241Medicaid
PA1022092320001Medicaid