Healthcare Provider Details

I. General information

NPI: 1205063849
Provider Name (Legal Business Name): DANIEL JAMES MULLINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2009
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 NORTHWESTERN DR
BLOOMFIELD CT
06002-3463
US

IV. Provider business mailing address

7 KEW GDNS
FARMINGTON CT
06032-1561
US

V. Phone/Fax

Practice location:
  • Phone: 860-242-8591
  • Fax:
Mailing address:
  • Phone: 203-455-4386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number53577
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: