Healthcare Provider Details

I. General information

NPI: 1700911153
Provider Name (Legal Business Name): SEAN WILLIAM MULVANEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 12/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11300 ROCKVILLE PIKE STE 615
ROCKVILLE MD
20852-3033
US

IV. Provider business mailing address

ROSM ANNAPOLIS 116 DEFENSE HIGHWAY SUITE 203
ANNAPOLIS MD
21401
US

V. Phone/Fax

Practice location:
  • Phone: 202-681-7671
  • Fax: 844-681-7671
Mailing address:
  • Phone: 410-505-0530
  • Fax: 410-505-0531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01055367A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number01055367A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberD0070210
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: