Provider Demographics
NPI:1841749272
Name:MULLANY, LAWRENCE DANIEL (MD MBA FACP)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:DANIEL
Last Name:MULLANY
Suffix:
Gender:M
Credentials:MD MBA FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12272 DECLARATION AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-3057
Mailing Address - Country:US
Mailing Address - Phone:941-779-3793
Mailing Address - Fax:
Practice Address - Street 1:12272 DECLARATION AVE
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836-3057
Practice Address - Country:US
Practice Address - Phone:941-779-3793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101257022207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease