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General NPI Number Information
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NPI Number | 1386642031
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Entity Type | Organization
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Legal Business Name | LOUIS G. DUSSEAULT, JR., MD, PC
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 825 WASHINGTON ST SUITE 370
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City | NORWOOD
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State | MA
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Zip | 02062-3441
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Country | US
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Telephone | 781-762-8427
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Fax | 781-762-2011
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Provider Business Mailing Address
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Address Line | 825 WASHINGTON ST SUITE 370
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City | NORWOOD
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State | MA
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Zip | 02062-3441
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Country | US
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Telephone | 781-762-8427
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Fax | 781-762-2011
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. KATHY ANN DUSSEAULT
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Credential | RN
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Telephone | 781-762-8427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 56357
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License Number State | MA
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