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General NPI Number Information
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NPI Number | 1699756247
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Entity Type | Individual
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Provider Name | MARK J. KULBASKI MD
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Gender | Male
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Dates
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Enumeration Date | 11/10/2005
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 1 PEARL ST SUITE 2000
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City | BROCKTON
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State | MA
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Zip | 02301
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Country | US
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Telephone | 508-584-4104
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Fax | 508-584-4105
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Provider Business Mailing Address
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Address Line | 960 MASSACHUSETTS AVENUE FL 2
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City | BOSTON
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State | MA
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Zip | 02118-2690
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 78343
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License Number State | MA
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