Provider Demographics
NPI:1497774806
Name:MULVEY, ANDREW WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:WILLIAM
Last Name:MULVEY
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 1:6333 S EAST ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-7107
Mailing Address - Country:US
Mailing Address - Phone:317-783-7474
Mailing Address - Fax:
Practice Address - Street 1:3369 STATE ROUTE 100
Practice Address - Street 2:
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18064-9613
Practice Address - Country:US
Practice Address - Phone:610-402-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050619A207P00000X
PAMD483514207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000090521OtherANTHEM
IN200256820Medicaid
IN000000365253OtherANTHEM
IN226540HMedicare PIN
INP00251192Medicare PIN
IN000000090521OtherANTHEM
G86032Medicare UPIN
IN930091597Medicare PIN