Active NPI
Erin Elizabeth Tully, MD
- Pediatrics Physician
- Philadelphia, PA
National Provider Identifier
1053949768
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- MD484578
- Practice address
- 3400 Spruce St
Philadelphia, PA 19104-4238 - Phone
- (215) 662-4000
- NPI assigned
- Mar 29, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | PA | ||
| Pediatrics Physician | 208000000X | MD484578 | PA | Primary |
Addresses
Primary practice location
3400 Spruce St
Philadelphia, PA 19104-4238
Mailing address
2929 Arch Street
Cira Center 12TH FL
Philadelphia, PA 19104-2857
Phone (717) 712-3841
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD484578 | PA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University of Penn - Medical Group | Current | Accepting new patients | |
| Childrens Health Care Associates, Inc | Current | Accepting new patients | |
| University of Penn-Medical Group | Current | Accepting new patients | |
| Trustees of the University of Pennsylvania | Current | Accepting new patients | |
| Childrens Health Care Associates, Inc | Pediatrics | Current | Accepting new patients |
| Childen'S Health Care Associates Inc. | Current | Accepting new patients | |
| Presbyterian Medical Center of the University of Pennsylvania Health S | Past | Accepting new patients |
Locations
3701 Market St
Ste 640
Philadelphia, PA 19104
Phone (215) 662-2250
3401 Civic Center Blvd
Philadelphia, PA 19104
Phone (215) 590-4040
3701 Market St
Fl 1
Philadelphia, PA 19104
Phone (215) 662-2250
Organizations & group practices 7
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.
-
- Pediatrics Physician
- Philadelphia, PA
- NPI 1598869059
-
- Internal Medicine Physician
- Philadelphia, PA
- NPI 1124882949
-
- Hospitalist Physician
- Philadelphia, PA
- NPI 1053447151
-
- Pediatric Registered Nurse
- Philadelphia, PA
- NPI 1699860643
-
- Pediatric Rehabilitation Medicine Physician
- Philadelphia, PA
- NPI 1386739332
-
- Surgical Oncology Physician
- Philadelphia, PA
- NPI 1871981985
-
- General Acute Care Hospital
- Philadelphia, PA
- NPI 1245207521
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1720569600000",
"number": "1053949768",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2929 ARCH STREET",
"address_2": "CIRA CENTER 12TH FL",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191042857",
"telephone_number": "717-712-3841"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3400 SPRUCE ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191044238",
"telephone_number": "215-662-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TULLY",
"first_name": "ERIN",
"middle_name": "ELIZABETH",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-03-29",
"last_updated": "2024-07-10",
"certification_date": "2024-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "PA",
"license": null,
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "PA",
"license": "MD484578",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.