Provider Demographics
NPI:1083695126
Name:MULQUEEN, JOHN F (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:MULQUEEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-2364
Mailing Address - Country:US
Mailing Address - Phone:978-630-2306
Mailing Address - Fax:978-630-3182
Practice Address - Street 1:190 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-2364
Practice Address - Country:US
Practice Address - Phone:978-630-2306
Practice Address - Fax:978-630-3182
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA70395208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3045501Medicaid
MAJ08066Medicare ID - Type Unspecified
E03198Medicare UPIN