Provider Demographics
NPI:1528070257
Name:TOLENTINO, JULIAN C (MD)
Entity type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:C
Last Name:TOLENTINO
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 1:316 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001
Mailing Address - Country:US
Mailing Address - Phone:724-282-1542
Mailing Address - Fax:724-282-3688
Practice Address - Street 1:316 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001
Practice Address - Country:US
Practice Address - Phone:724-282-1542
Practice Address - Fax:724-282-3688
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034425L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
084165OtherHIGHMARK/BLUE SHIELD
PA006468800001Medicaid
B35290Medicare UPIN
084165Medicare PIN