Individual
PROF. VIKRAMADITYA DULAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
140 JEFFERSON DAVIS BLVD, NATCHEZ, MS 39120-5104
(601) 304-9718
(601) 304-9637
Mailing address
140 JEFFERSON DAVIS BLVD, NATCHEZ, MS 39120-5104
(601) 304-9718
(601) 304-9637
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
18344
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02602371
—
MS
01
—
1197785
LOUISIANA MEDICAID
—
Enumeration date
06/10/2006
Last updated
06/09/2022
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