Healthcare Provider Details

I. General information

NPI: 1073695888
Provider Name (Legal Business Name): RICHARD W. CULLEN, DPM, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CHESTNUT ST
NEEDHAM MA
02492-2497
US

IV. Provider business mailing address

300 CHESTNUT ST SUITE 500
NEEDHAM MA
02492-2497
US

V. Phone/Fax

Practice location:
  • Phone: 781-444-2496
  • Fax: 781-444-4961
Mailing address:
  • Phone: 781-444-7137
  • Fax: 781-444-4961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1693
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number1693
License Number StateMA

VIII. Authorized Official

Name: DIANE CULLEN
Title or Position: MANAGER
Credential:
Phone: 781-444-7137