1235136870 NPI number — DR. MIRIAM J MULLIN MD

Table of content: DR. MIRIAM J MULLIN MD (NPI 1235136870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235136870 NPI number — DR. MIRIAM J MULLIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MULLIN
Provider First Name:
MIRIAM
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235136870
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
722 YORKLYN RD
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
HOCKESSIN
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19707-8718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-235-2351
Provider Business Mailing Address Fax Number:
302-235-2365

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
722 YORKLYN RD
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
HOCKESSIN
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19707-8718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-235-2351
Provider Business Practice Location Address Fax Number:
302-235-2365
Provider Enumeration Date:
06/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  C10007124 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 510279425 . This is a "BCBS OF DELAWARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 7063548 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: PIN 00062633 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 198587 . This is a "COVENTRY HEALTHCARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 2360820 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 8116364 . This is a "MAMSI" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 1000024574 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50071 . This is a "MID ATLANTIC HEALTH" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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