Provider Demographics
NPI:1093749756
Name:LULOFF, MARTIN R (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:R
Last Name:LULOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:74 GORDONS WAY
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05250
Mailing Address - Country:US
Mailing Address - Phone:508-435-5506
Mailing Address - Fax:
Practice Address - Street 1:140 HOSPITAL DR
Practice Address - Street 2:SUITE 207
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-5009
Practice Address - Country:US
Practice Address - Phone:802-447-3930
Practice Address - Fax:802-447-8539
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA43877208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA12-01279OtherUNITED HEALTHCARE
MA043877OtherTUFTS
MA20017OtherHEALTHSOURCE(CMHC)
MA451063OtherAETNA/US HEALTHCARE
MAE45016OtherBLUE CROSS/BLUE SHIELD
MA4223701OtherAETNA
MA20700OtherHARVARD PILGRIM
MAB10096001OtherCIGNA
MA2072734Medicaid
MAE45016OtherBLUE CROSS/BLUE SHIELD