Provider Demographics
NPI:1700852951
Name:CULLEN, RICHARD W (DPM)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:W
Last Name:CULLEN
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:300 CHESTNUT ST
Mailing Address - Street 2:SUITE500
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-2497
Mailing Address - Country:US
Mailing Address - Phone:781-444-7137
Mailing Address - Fax:781-444-4961
Practice Address - Street 1:300 CHESTNUT ST
Practice Address - Street 2:SUITE500
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2497
Practice Address - Country:US
Practice Address - Phone:781-444-7137
Practice Address - Fax:781-444-4961
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2012-08-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA1693213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA702718OtherTUFTS
MA41790OtherFALLON COMM HEALTH PLAN
MAY70754OtherBLUE CROSS BLUE SHIELD
MAY70754OtherBLUE CROSS BLUE SHIELD