Provider Demographics
NPI:1598861528
Name:MULDOON, LAWRENCE DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:DANIEL
Last Name:MULDOON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:425 POST RD
Mailing Address - Street 2:GREATER BRIDGEPORT UROLOGY
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6232
Mailing Address - Country:US
Mailing Address - Phone:203-254-1576
Mailing Address - Fax:203-254-1809
Practice Address - Street 1:425 POST RD
Practice Address - Street 2:GREATER BRIDGEPORT UROLOGY
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6232
Practice Address - Country:US
Practice Address - Phone:203-254-1576
Practice Address - Fax:203-254-1809
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT030710208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0174853OtherCIGNA
CT010030710CT01OtherBC/BS
CT25201OtherOXFORD
CT001307108Medicaid
CT002195OtherHEALTHNET
CT25201OtherOXFORD
CT010030710CT01OtherBC/BS