Healthcare Provider Details

I. General information

NPI: 1104890425
Provider Name (Legal Business Name): MICHAEL P MULREANY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE
BETHESDA MD
20889-5001
US

IV. Provider business mailing address

12608 CELTIC CT
ROCKVILLE MD
20850-3769
US

V. Phone/Fax

Practice location:
  • Phone: 301-294-4959
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberMD068369L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: