Provider Demographics
NPI:1053343822
Name:PHONEDOCTORX, LLC
Entity type:Organization
Organization Name:PHONEDOCTORX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:I
Authorized Official - Last Name:BULAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-961-5184
Mailing Address - Street 1:PO BOX 70280
Mailing Address - Street 2:370 FAUNCE CORNER RD
Mailing Address - City:N DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-0280
Mailing Address - Country:US
Mailing Address - Phone:866-539-7379
Mailing Address - Fax:508-998-8006
Practice Address - Street 1:221 FITZGERALD DR
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745-3426
Practice Address - Country:US
Practice Address - Phone:508-996-4600
Practice Address - Fax:508-990-1411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM21812Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER