Provider Demographics
NPI:1467443861
Name:MULKERN, JOHN P (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:MULKERN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:700 CONGRESS ST
Mailing Address - Street 2:STE 303
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0909
Mailing Address - Country:US
Mailing Address - Phone:617-770-4411
Mailing Address - Fax:617-786-8793
Practice Address - Street 1:700 CONGRESS ST
Practice Address - Street 2:STE 303
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0909
Practice Address - Country:US
Practice Address - Phone:617-770-4411
Practice Address - Fax:617-786-8793
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2010-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA80109207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0100518OtherUNITED
MA70451OtherHPHC
MA463720OtherCIGNA
MA3131602Medicaid
80109OtherTUFTS
MAJ14803OtherBCBS
MA3131602Medicaid
MAJ14803OtherBCBS