Provider Demographics
NPI:1528597549
Name:MULHOLLAND, CHRISTOPHER MARK (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MARK
Last Name:MULHOLLAND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 SUGARTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-3137
Mailing Address - Country:US
Mailing Address - Phone:484-367-7460
Mailing Address - Fax:484-367-7439
Practice Address - Street 1:215 SUGARTOWN RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3137
Practice Address - Country:US
Practice Address - Phone:484-367-7460
Practice Address - Fax:484-367-7439
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS020055207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOS020055OtherPENNSYLVANIA DEPARTMENT OF STATE - PROFESSIONAL LICENSING BOARD