Provider Demographics
NPI:1588675698
Name:ZULLO, MARK C (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:ZULLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:70 KENYON AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-4239
Mailing Address - Country:US
Mailing Address - Phone:401-789-8543
Mailing Address - Fax:401-782-8766
Practice Address - Street 1:70 KENYON AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-4239
Practice Address - Country:US
Practice Address - Phone:401-789-8543
Practice Address - Fax:401-782-8766
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2015-04-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
RI06480207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ11769OtherMABC
MA052518OtherTUFTS
MA35998OtherFALLON
0101102OtherUHC
400988OtherRI BLUE CHIP
MAB10350101OtherCIGNA
MA000000028143OtherBMC HEALTHNET
MA3043355Medicaid
MA710716OtherHPHC
400988OtherRI BLUE CHIP
MA3043355Medicaid