Healthcare Provider Details

I. General information

NPI: 1295960474
Provider Name (Legal Business Name): CHRISTINE ANNE MULLIGAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 RIVERSIDE AVE STE 2
MEDFORD MA
02155-4600
US

IV. Provider business mailing address

PO BOX 24532
NEW YORK NY
10087-4532
US

V. Phone/Fax

Practice location:
  • Phone: 781-306-0200
  • Fax: 781-306-0264
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number251057
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: