Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 0101258410 | VA |
Y | 207PP0204X | Pediatric Emergency Physician | 0101258410 | VA |
N | 208000000X | Pediatrician | MD429329 | PA |
N | 208000000X | Pediatrician | N5267 | TX |
N | 2080P0204X | Pediatric Emergency Doctor | 040772 | DC |
NPI | 1063742328 |
---|---|
Provider Name | Dr. Paul Mullan |
First Address | Norfolk, VA 23507-1910 |
Second Address | Norfolk, VA 23507-1910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2010 |
Last Update Date | 16/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
209047403 | (05) | TX |