=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134171671
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALAN BULOTSKY, MD & ASSOCIATES, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2006
-----------------------------------------------------
Last Update Date | 03/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 QUINCY ST
-----------------------------------------------------
City | BROCKTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02302-2926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-584-1890
-----------------------------------------------------
Fax | 508-580-3332
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 QUINCY ST
-----------------------------------------------------
City | BROCKTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02302-2926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-584-1890
-----------------------------------------------------
Fax | 508-580-3332
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MARK A. HAUSMAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 508-584-1890
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------