Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RN0300X | Nephrologist | 035565 | CT |
Y | 207RN0300X | Nephrologist | 55789 | MA |
NPI | 1063402105 |
---|---|
Provider Name | Dr. Jeffrey G Mulhern |
First Address | Ludlow, MA 01056-0366 |
Second Address | West Springfield, MA 01089-1320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2005 |
Last Update Date | 11/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003089150 | (05) | CT |
110048323A | (05) | MA |