Provider Demographics
NPI:1598810715
Name:TALUSAN, EDUARDO DIZON (MD)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:DIZON
Last Name:TALUSAN
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 1:966 PARK ST
Mailing Address - Street 2:SUITE B4
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3650
Mailing Address - Country:US
Mailing Address - Phone:781-344-1025
Mailing Address - Fax:781-344-1027
Practice Address - Street 1:966 PARK ST
Practice Address - Street 2:SUITE B4
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-3650
Practice Address - Country:US
Practice Address - Phone:781-344-1025
Practice Address - Fax:781-344-1027
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2013-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA43555174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0150657Medicaid
MA0150657Medicaid
MAA40132Medicare UPIN