Basic Information
| Provider Information | |||||||||
| NPI: | 1902863509 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MULVEY | ||||||||
| FirstName: | JOHN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1753 | ||||||||
| Address2: | |||||||||
| City: | ELKTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219221753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103984679 | ||||||||
| FaxNumber: | 4106203686 | ||||||||
| Practice Location | |||||||||
| Address1: | 104 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ELKTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219215509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109968990 | ||||||||
| FaxNumber: | 4109968912 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 11/01/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | D0045155 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | C10004236 | DE | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.