Provider Demographics
NPI:1699202275
Name:MULLER, IMELDA (MD)
Entity Type:Individual
Prefix:
First Name:IMELDA
Middle Name:
Last Name:MULLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 MILLERBROOK LN
Mailing Address - Street 2:
Mailing Address - City:COPAKE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12517-5409
Mailing Address - Country:US
Mailing Address - Phone:518-929-6217
Mailing Address - Fax:
Practice Address - Street 1:NAVAL MEDICAL CENTER 34800 BOB WILSON DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-0001
Practice Address - Country:US
Practice Address - Phone:619-532-5998
Practice Address - Fax:619-532-5507
Is Sole Proprietor?:No
Enumeration Date:2017-05-15
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAVAD0000Medicaid