Provider Demographics
NPI:1255465571
Name:MULLIGAN, CHARLES R JR (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:R
Last Name:MULLIGAN
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:200 HYGEIA DR
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2049
Mailing Address - Country:US
Mailing Address - Phone:434-200-3100
Mailing Address - Fax:434-200-5307
Practice Address - Street 1:4701 OGLETOWN STANTON ROAD
Practice Address - Street 2:HELEN F. GRAHAM CANCER CENTER, SUITE 2100
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-623-4530
Practice Address - Fax:434-200-5307
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2014-11-10
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Provider Licenses
StateLicense IDTaxonomies
SC15191208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE004041C98Medicare PIN