Provider Demographics
NPI:1396035143
Name:MULHEARN, NICHOLAS J (DO)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:J
Last Name:MULHEARN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:765 LIBERTY STREET
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335
Mailing Address - Country:US
Mailing Address - Phone:814-336-6384
Mailing Address - Fax:614-722-4380
Practice Address - Street 1:765 LIBERTY STREET
Practice Address - Street 2:SUITE 111
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335
Practice Address - Country:US
Practice Address - Phone:814-336-6384
Practice Address - Fax:614-722-4380
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34011357208000000X, 2080P0204X
PAOS-0170852080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0103856Medicaid