Provider Demographics
NPI:1861450389
Name:BULLOCK, ALAN HOWARD (MD)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:HOWARD
Last Name:BULLOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3455 MAIN STREET
Mailing Address - Street 2:STE 2
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1140
Mailing Address - Country:US
Mailing Address - Phone:413-746-9142
Mailing Address - Fax:413-746-2455
Practice Address - Street 1:3455 MAIN STREET
Practice Address - Street 2:STE 2
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1140
Practice Address - Country:US
Practice Address - Phone:413-746-9142
Practice Address - Fax:413-746-2455
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39776207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
782607OtherAETNA
19468OtherCHP
MA2044986Medicaid
7092358002OtherCIGNA
00000002511OtherHEALTH NET
171149OtherHARVARD PILGRIM
782607OtherUS HEALTHCARE
N51651OtherBLUE SHIELD
S025856 OR 368515OtherCHAMPUS TRICARE
0018811OtherNEIGHBORHOOD H
039776OtherTUFTS
2044986OtherMASS HEALTH
397760OtherCONNECTICARE
29340OtherHNE
N51651OtherHMO BLUE
039776OtherTUFTS
N51651Medicare ID - Type Unspecified