Provider Demographics
NPI:1003837923
Name:KULICH, RONALD JON (PHD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JON
Last Name:KULICH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:15 PARKMAN STREET
Practice Address - Street 2:WAC 3 ANESTHESIA PAIN MANAGEMENT
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3117
Practice Address - Country:US
Practice Address - Phone:617-726-3332
Practice Address - Fax:617-726-9210
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA3418103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW03810OtherBCBS MA
MA0515051Medicaid
MA732541OtherTUFTS HEALTH PLAN
R96633Medicare UPIN
MAW03810Medicare ID - Type Unspecified