Provider Demographics
NPI:1437120490
Name:RULLO, DAVID J (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:RULLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 EMERSON CIR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-2852
Mailing Address - Country:US
Mailing Address - Phone:508-339-4102
Mailing Address - Fax:
Practice Address - Street 1:117 SUTTON RD
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-3214
Practice Address - Country:US
Practice Address - Phone:781-400-5900
Practice Address - Fax:781-400-5900
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79281174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist