Healthcare Provider Details

I. General information

NPI: 1336671056
Provider Name (Legal Business Name): DOUGLAS JOSEPH DICOLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ONEIL BLVD
ATTLEBORO MA
02703-4250
US

IV. Provider business mailing address

100 ONEIL BLVD
ATTLEBORO MA
02703-4250
US

V. Phone/Fax

Practice location:
  • Phone: 508-342-1103
  • Fax: 508-342-1945
Mailing address:
  • Phone: 508-342-1103
  • Fax: 508-342-1945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number290178
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: