Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | MD039755E | PA |
N | 2080P0204X | Pediatric Emergency Doctor | MD039755E | PA |
N | 2080P0206X | Pediatric Gastroenterologist | MD039755E | PA |
NPI | 1184630808 |
---|---|
Provider Name | Andrew E Mulberg |
First Address | Camden, NJ 08103-1438 |
Second Address | Camden, NJ 08103-1438 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 28/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001436126 | (05) | PA |
6039707 | (05) | NJ |
F69983 | (02) |