Active NPI
Mary Kathleen Ditullio, CRNP
- Nurse Practitioner
- Erie, PA
National Provider Identifier
1053304998
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- VP003581G
- Practice address
- 17 Merline Ave
Erie, PA 16509-1567 - Phone
- (814) 868-9484
- Fax
- (814) 866-5904
- NPI assigned
- Aug 25, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | VP003581G | PA | Primary |
Addresses
Primary practice location
17 Merline Ave
Erie, PA 16509-1567
Mailing address
17 Merline Ave
Erie, PA 16509-1567
Phone (814) 868-9484
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1988988 | Other | PA | BLUE SHIELD |
| 1565773 | Other | PA | GATEWAY |
| P00406374 | Other | PA | RR MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| VP003581G | PA | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bayside Obstetrics Gynecology and Infertility Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Obstetrics & Gynecology Physician
- Erie, PA
- NPI 1932192879
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124928000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366070400000",
"number": "1053304998",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17 MERLINE AVE",
"city": "ERIE",
"state": "PA",
"postal_code": "165091567",
"telephone_number": "814-868-9484",
"fax_number": "814-866-5904"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17 MERLINE AVE",
"city": "ERIE",
"state": "PA",
"postal_code": "165091567",
"telephone_number": "814-868-9484",
"fax_number": "814-866-5904"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DITULLIO",
"first_name": "MARY",
"middle_name": "KATHLEEN",
"credential": "CRNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-08-25",
"last_updated": "2013-04-16",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "PA",
"license": "VP003581G",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "1988988",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GATEWAY",
"identifier": "1565773",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00406374",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Erie, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.