Provider Demographics
NPI:1528005782
Name:BELLUCCI, MITCHELL JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:JOSEPH
Last Name:BELLUCCI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 EDWARD ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2303
Mailing Address - Country:US
Mailing Address - Phone:781-828-3533
Mailing Address - Fax:781-828-2471
Practice Address - Street 1:192 WEST ST
Practice Address - Street 2:SUITE 4
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2239
Practice Address - Country:US
Practice Address - Phone:508-478-6205
Practice Address - Fax:508-478-5139
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA56178207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA130554OtherHARVARD PILGRIM HEALTH
MA3912OtherFALLON HEALTH PLAN
MA709081OtherTUFTS HEALTH PLAN
MA3011488Medicaid
MAJ05794OtherBLUE CROSS & BLUE SHIELD
MA130554OtherHARVARD PILGRIM HEALTH
MAJ05794OtherBLUE CROSS & BLUE SHIELD