Provider Demographics
NPI:1306807334
Name:LULEY, RICHARD F (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:F
Last Name:LULEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 S 2ND ST
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 S FRONT ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101
Practice Address - Country:US
Practice Address - Phone:717-782-3380
Practice Address - Fax:717-782-5716
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029960E207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001120442Medicaid
PA01645303OtherCAPITAL BLUE CROSS
A16025Medicare UPIN
PA149723KAGMedicare PIN
PA0011204420005Medicaid
PA149723RQJMedicare PIN
A16025Medicare UPIN