Provider Demographics
NPI:1821092610
Name:MULLEN, DAVID S (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:MULLEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:777 ECHO LAKE RD UNIT F
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-6618
Mailing Address - Country:US
Mailing Address - Phone:860-274-1773
Mailing Address - Fax:860-945-6820
Practice Address - Street 1:464 WOLCOTT RD
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716-2626
Practice Address - Country:US
Practice Address - Phone:203-879-3646
Practice Address - Fax:203-879-7191
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000766213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004223715Medicaid
CT030000766CT01OtherBLUECROSS AND SHEILD
2V4427OtherHEALTHNET
P2864777OtherOXFORD HEALTH PLANS
CT00422371500OtherBLUECARE FAMILY PLAN
5896507OtherCIGNA HEALTH PLANS
2940733OtherAETNA HEALTH PLANS
076600OtherCONNECTICARE INC
480034412OtherRAILROAD MEDICARE
2940733OtherAETNA HEALTH PLANS
U90917Medicare UPIN