Healthcare Provider Details

I. General information

NPI: 1699952853
Provider Name (Legal Business Name): EVELYN M. MULLIGAN MB BCH BAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 CORBIN AVE
NEW BRITAIN CT
06053-2298
US

IV. Provider business mailing address

2150 CORBIN AVE
NEW BRITAIN CT
06053-2298
US

V. Phone/Fax

Practice location:
  • Phone: 860-832-6305
  • Fax:
Mailing address:
  • Phone: 860-612-6305
  • 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 StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number047078
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: