Healthcare Provider Details

I. General information

NPI: 1528005782
Provider Name (Legal Business Name): MITCHELL JOSEPH BELLUCCI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 WEST ST SUITE 4
MILFORD MA
01757-2239
US

IV. Provider business mailing address

1 EDWARD ST
CANTON MA
02021-2303
US

V. Phone/Fax

Practice location:
  • Phone: 508-478-6205
  • Fax: 508-478-5139
Mailing address:
  • Phone: 781-828-3533
  • Fax: 781-828-2471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number56178
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: