Provider Demographics
NPI:1760421234
Name:DULAC, JOSEPH M (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:DULAC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1595 BRIDGE ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-2614
Mailing Address - Country:US
Mailing Address - Phone:978-323-2808
Mailing Address - Fax:978-323-2810
Practice Address - Street 1:1595 BRIDGE ST
Practice Address - Street 2:SUITE 3
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-2614
Practice Address - Country:US
Practice Address - Phone:978-323-2808
Practice Address - Fax:978-323-2810
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA158243207Q00000X
NH10205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30200634Medicaid
NHH03922Medicare UPIN
NHRE5582Medicare ID - Type Unspecified