Healthcare Provider Details

I. General information

NPI: 1760421234
Provider Name (Legal Business Name): JOSEPH M. DULAC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1595 BRIDGE ST SUITE 3
DRACUT MA
01826-2614
US

IV. Provider business mailing address

1595 BRIDGE ST SUITE 3
DRACUT MA
01826-2614
US

V. Phone/Fax

Practice location:
  • Phone: 978-323-2808
  • Fax: 978-323-2810
Mailing address:
  • Phone: 978-323-2808
  • Fax: 978-323-2810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number10205
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number158243
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: