Provider Demographics
NPI:1083723068
Name:MULLARKY, KEVIN HENRY (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:HENRY
Last Name:MULLARKY
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 1:22 W COLE RD
Mailing Address - Street 2:C
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9430
Mailing Address - Country:US
Mailing Address - Phone:207-284-0176
Mailing Address - Fax:207-286-8792
Practice Address - Street 1:22 W COLE RD
Practice Address - Street 2:C
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9430
Practice Address - Country:US
Practice Address - Phone:207-284-0176
Practice Address - Fax:207-286-8792
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD127222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME13204000Medicaid
MEEX5019Medicare PIN
ME13204000Medicaid
MEMM3717Medicare PIN