Provider Demographics
NPI:1861652240
Name:DULALA, RENUKA (MD)
Entity type:Individual
Prefix:DR
First Name:RENUKA
Middle Name:
Last Name:DULALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-2223
Mailing Address - Country:US
Mailing Address - Phone:413-534-2543
Mailing Address - Fax:413-534-2655
Practice Address - Street 1:575 BEECH ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-2223
Practice Address - Country:US
Practice Address - Phone:413-534-2543
Practice Address - Fax:413-534-2655
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA258935207R00000X, 207RH0003X, 207RH0000X
CT038811207RH0003X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010038811CT02OtherBLUE CROSS/BLUE SHIELD
CT001388116Medicaid
CT001388116Medicaid
CTD400003897Medicare PIN