Provider Demographics
NPI:1063527950
Name:BULLON, ANTONIO E (MD)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:E
Last Name:BULLON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:47 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748-2121
Mailing Address - Country:US
Mailing Address - Phone:617-905-7103
Mailing Address - Fax:617-499-5419
Practice Address - Street 1:330 MOUNT AUBURN ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5502
Practice Address - Country:US
Practice Address - Phone:617-905-7103
Practice Address - Fax:617-499-5419
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1528352084P0805X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty