Provider Demographics
NPI:1487639449
Name:MULLIGAN, DAVID C (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:MULLIGAN
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 1:333 CEDAR ST
Mailing Address - Street 2:FMB 121
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3206
Mailing Address - Country:US
Mailing Address - Phone:203-737-2804
Mailing Address - Fax:203-785-7162
Practice Address - Street 1:333 CEDAR ST
Practice Address - Street 2:FMB 121
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3206
Practice Address - Country:US
Practice Address - Phone:203-737-2804
Practice Address - Fax:203-785-7162
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26494204F00000X, 208600000X
CT54296204F00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ429755Medicaid
AZ86080015085259A462OtherTRIWEST
AZ020038526OtherRAILROAD MEDICARE
AZ020038526OtherRAILROAD MEDICARE
AZZ22782Medicare PIN
C71201Medicare UPIN