Provider Demographics
NPI:1588769236
Name:CIRAULO, DOMENIC A (MD)
Entity type:Individual
Prefix:
First Name:DOMENIC
Middle Name:A
Last Name:CIRAULO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 TER HEUN DR
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-2525
Mailing Address - Country:US
Mailing Address - Phone:508-540-6550
Mailing Address - Fax:508-563-3548
Practice Address - Street 1:200 TER HEUN DR
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2525
Practice Address - Country:US
Practice Address - Phone:508-540-6550
Practice Address - Fax:508-563-3548
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA411532084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110042957AMedicaid
B33538Medicare ID - Type Unspecified