Physician Compare National (NPI:1194767806)

HEALTHCARE PROVIDER: VIKRAMADITYA DULAM M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1194767806
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7618940446
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040818001091
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DULAM
	Individual professional last name
Provider First Name	VIKRAMADITYA
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1992
	Individual professional's medical school graduation year
Primary Specialty	CARDIOVASCULAR DISEASE (CARDIOLOGY)
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	INTERNAL MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	INTERNAL MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	54 SERGEANT PRENTISS DR
	Group Practice or individual's line 1 address
City	NATCHEZ
	Group Practice or individual's city
State	MS
	Group Practice or individual's state
Zip Code	391204726
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	250084
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MERIT HEALTH NATCHEZ
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	191318
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	RIVERLAND MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	250031
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	MERIT HEALTH RIVER REGION
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y