MEDICARE: DR. MAURA MULLOY PHD

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	103T00000X	Psychologist	05975	MD

General Provider Information

NPI Number	:	1366957979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAURA MULLOY PHD

Provider Business Mailing Address
First Line	:	1111 NOTLEY RD
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-6243
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 NOTLEY RD
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-6243
Country	:	US
Telephone Number	:	703-408-2867
Fax Number	:

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

Provider Enumeration Date	:	12/05/2017
Last Update Date	:	12/05/2017

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