Provider Demographics
NPI: | 1558556217 |
---|---|
Name: | DUMLAO, THEMY F JR (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | THEMY |
Middle Name: | F |
Last Name: | DUMLAO |
Suffix: | JR |
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: | 70 PLEASANT ST |
Mailing Address - Street 2: | |
Mailing Address - City: | WEYMOUTH |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 02190-2427 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 781-331-2000 |
Mailing Address - Fax: | 781-337-6104 |
Practice Address - Street 1: | 70 PLEASANT ST |
Practice Address - Street 2: | |
Practice Address - City: | WEYMOUTH |
Practice Address - State: | MA |
Practice Address - Zip Code: | 02190-2427 |
Practice Address - Country: | US |
Practice Address - Phone: | 781-331-2000 |
Practice Address - Fax: | 781-337-6104 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-09-06 |
Last Update Date: | 2013-11-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MA | 234085 | 207RC0000X |
NY | 240168 | 207RC0000X, 207UN0901X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No | 207UN0901X | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MA | 003313001 | Medicare PIN | |
NY | J400052698 | Medicare PIN |