Healthcare Provider Details

I. General information

NPI: 1235136870
Provider Name (Legal Business Name): MIRIAM J MULLIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 05/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 YORKLYN RD SUITE 400
HOCKESSIN DE
19707-8718
US

IV. Provider business mailing address

722 YORKLYN RD SUITE 400
HOCKESSIN DE
19707-8718
US

V. Phone/Fax

Practice location:
  • Phone: 302-235-2351
  • Fax: 302-235-2365
Mailing address:
  • Phone: 302-235-2351
  • Fax: 302-235-2365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC10007124
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: