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NPI Code Detail

MEDICARE: RAEVA MULLOTH

MEDICARE: RAEVA MULLOTH
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
12084N0400XNeurology PhysicianMT236360PA

General Provider Information

NPI Number : 1679419311
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAEVA MULLOTH
Provider Business Mailing Address
First Line : 2403 BUTLER ST
Second Line :
City : EASTON
State : PA
Zip : 18042-5302
Country : US
Telephone Number : 484-526-5210
Fax Number : 866-568-6561
Provider Business Practice Location Address
First Line : 2403 BUTLER ST
Second Line :
City : EASTON
State : PA
Zip : 18042-5302
Country : US
Telephone Number : 484-526-5210
Fax Number : 866-568-6561
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2026
Last Update Date : 04/27/2026

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Directions to “ RAEVA MULLOTH ” Practice Location

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