Provider Demographics
NPI:1710976642
Name:MULLA, WADIA R (MD)
Entity Type:Individual
Prefix:
First Name:WADIA
Middle Name:R
Last Name:MULLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:640 S STATE ST
Mailing Address - Street 2:742 BUILDING
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-3530
Mailing Address - Country:US
Mailing Address - Phone:302-674-3970
Mailing Address - Fax:302-672-2350
Practice Address - Street 1:1060 S GOVERNORS AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-6920
Practice Address - Country:US
Practice Address - Phone:302-744-6220
Practice Address - Fax:302-734-8454
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD043899L207SG0201X, 207V00000X, 207VM0101X
DEC1-0004719207VX0000X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001243406005Medicaid
001380ZA5HOtherGROUP MEMBER PTAN
PA001243406005Medicaid
001380ZA5HOtherGROUP MEMBER PTAN