Healthcare Provider Details

I. General information

NPI: 1245231554
Provider Name (Legal Business Name): LISA PATRICIA MULLIGAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NATIONAL NAVAL MEDICAL CENTER/ DEPT OF NEUROSURGER 8901 WISCONSIN AVE. BLDG. 9, 2ND DECK
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

3813 LAWRENCE AVE
KENSINGTON MD
20895-1534
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4421
  • Fax: 301-295-4430
Mailing address:
  • Phone: 301-295-4429
  • Fax: 301-295-4430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberD0046475
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: