MEDICARE: DR. JANICE MICHELLE P-TRULL DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	236883	MA

General Provider Information

NPI Number	:	1528171188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANICE MICHELLE P-TRULL DO

Provider Business Mailing Address
First Line	:	230 WASHINGTON STREET
Second Line	:
City	:	SOUTH ATTLEVORO
State	:	MA
Zip	:	02703-5518
Country	:	US
Telephone Number	:	508-761-5650
Fax Number	:	508-761-9870

Provider Business Practice Location Address
First Line	:	230 WASHINGTON STREET
Second Line	:
City	:	SOUTH ATTLEVORO
State	:	MA
Zip	:	02703-5518
Country	:	US
Telephone Number	:	508-761-5650
Fax Number	:	508-761-9870

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	09/06/2013

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