Provider Demographics
NPI:1457081135
Name:KIRAN S. LULLA MD, PC
Entity Type:Organization
Organization Name:KIRAN S. LULLA MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHILD AND ADOLESCENT PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LULLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MBA
Authorized Official - Phone:781-434-8639
Mailing Address - Street 1:720 WELLESLEY ST
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-1000
Mailing Address - Country:US
Mailing Address - Phone:781-237-5687
Mailing Address - Fax:
Practice Address - Street 1:219 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-3105
Practice Address - Country:US
Practice Address - Phone:781-434-8639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty