Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3418 | MA |
Y | 103T00000X | Psychologist | 3418 | MA |
NPI | 1003837923 |
---|---|
Provider Name | Dr. Ronald Jon Kulich |
First Address | Charlestown, MA 02129-9142 |
Second Address | Boston, MA 02114-3117 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0515051 | (05) | MA |
732541 | TUFTS HEALTH PLAN (01) | MA |
R96633 | (02) | |
W03810 | BCBS MA (01) | MA |