Provider Demographics
NPI:1629369608
Name:BARTOLOME, RUBY IRISH BULAK (DO)
Entity Type:Individual
Prefix:MS
First Name:RUBY IRISH
Middle Name:BULAK
Last Name:BARTOLOME
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 WASHINGTON STREET
Mailing Address - Street 2:BOX 286
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111
Mailing Address - Country:US
Mailing Address - Phone:617-636-8182
Mailing Address - Fax:617-636-1425
Practice Address - Street 1:800 WASHINGTON STREET
Practice Address - Street 2:BOX 286
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111
Practice Address - Country:US
Practice Address - Phone:617-636-8182
Practice Address - Fax:617-636-1425
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT53181208000000X
MA262466208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics