Basic Information
| Provider Information | |||||||||
| NPI: | 1609856020 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TULACRO | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | |||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 999 SUMMER ST | ||||||||
| Address2: | 304 | ||||||||
| City: | STAMFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 069055546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033255700 | ||||||||
| FaxNumber: | 2033258080 | ||||||||
| Practice Location | |||||||||
| Address1: | 999 SUMMER ST | ||||||||
| Address2: | 304 | ||||||||
| City: | STAMFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 069055546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033255700 | ||||||||
| FaxNumber: | 2033258080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2006 | ||||||||
| LastUpdateDate: | 01/20/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 000947 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 000947 | 01 | CT | STATE LICENSE | OTHER |