Healthcare Provider Details

I. General information

NPI: 1124072442
Provider Name (Legal Business Name): JOANNE P MULLIGAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANNE P MULLIGAN PAC

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 W BROAD ST STE 170
BETHLEHEM PA
18018-5738
US

IV. Provider business mailing address

PO BOX 1754
ALLENTOWN PA
18105-1754
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-1260
  • Fax: 484-526-1265
Mailing address:
  • Phone: 610-798-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA051958
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: