MEDICARE: BENJAMIN MULKEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	0101272312	VA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1124522115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN MULKEY M.D.

Provider Business Mailing Address
First Line	:	213 S JEFFERSON ST STE 1006
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24011-1713
Country	:	US
Telephone Number	:	540-224-5516
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 CRYSTAL SPRING AVE SW STE 203
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24014-2465
Country	:	US
Telephone Number	:	540-982-8204
Fax Number	:	540-224-1059

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2018
Last Update Date	:	06/04/2026

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