Provider Demographics
NPI:1235108382
Name:TULLER, JANE KENDALL (MD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:KENDALL
Last Name:TULLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-2554
Mailing Address - Country:US
Mailing Address - Phone:215-345-2202
Mailing Address - Fax:267-880-1393
Practice Address - Street 1:595 W. STATE STREET
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901
Practice Address - Country:US
Practice Address - Phone:215-345-2202
Practice Address - Fax:267-880-1393
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052777L207R00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01479992Medicaid
PA01479992Medicaid
PA757516Medicare ID - Type Unspecified