Provider Demographics
NPI:1972546224
Name:MARK TULER DPM
Entity type:Organization
Organization Name:MARK TULER DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:TULER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:781-893-8208
Mailing Address - Street 1:32 SOUTH ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-3594
Mailing Address - Country:US
Mailing Address - Phone:781-893-8208
Mailing Address - Fax:
Practice Address - Street 1:32 SOUTH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-3594
Practice Address - Country:US
Practice Address - Phone:781-893-8208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1683213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9772715Medicaid
MAT58747Medicare UPIN
MAY77139Medicare ID - Type Unspecified
MA1272480001Medicare NSC