Provider Demographics
NPI:1275539561
Name:MULCAHY, MAUREEN M (MD)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:M
Last Name:MULCAHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17704 JEAN WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035
Mailing Address - Country:US
Mailing Address - Phone:503-699-0370
Mailing Address - Fax:971-236-9099
Practice Address - Street 1:17704 JEAN WAY
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-5497
Practice Address - Country:US
Practice Address - Phone:503-699-0370
Practice Address - Fax:971-236-9099
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18995207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR130048Medicaid
OR130048Medicaid
690131Medicare UPIN