Provider Demographics
NPI:1386102176
Name:DULAN, RACHELLE M (DO)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:M
Last Name:DULAN
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 MCCRAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-9277
Mailing Address - Country:US
Mailing Address - Phone:513-607-1110
Mailing Address - Fax:
Practice Address - Street 1:405 W GRAND AVE STE 3003
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-7538
Practice Address - Country:US
Practice Address - Phone:937-294-3603
Practice Address - Fax:937-294-3617
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.015968207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHTJ536197OtherOHIO DRIVERS LICENSE NUMBER