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General NPI Number Information
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NPI Number | 1841505369
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Entity Type | Individual
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Provider Name | FOZAN ALDULAIJAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/09/2010
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Last Update Date | 08/09/2010
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Provider Practice Location Address
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Address Line | 725 NORTH ST
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City | PITTSFIELD
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State | MA
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Zip | 01201-4109
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Country | US
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Telephone | 413-881-5456
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Fax |
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Provider Business Mailing Address
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Address Line | 70 LAKE ST APT C
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City | DALTON
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State | MA
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Zip | 01226-1386
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Country | US
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Telephone | 713-367-7414
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 244998
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License Number State | MA
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