Provider Demographics
NPI:1457675050
Name:MULLA, CHRISTOPHER MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MATTHEW
Last Name:MULLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 DEWITT LOOP
Mailing Address - Street 2:ENDOCRINOLOGY SERVICE
Mailing Address - City:FORT BELVOIR
Mailing Address - State:AE
Mailing Address - Zip Code:22060
Mailing Address - Country:US
Mailing Address - Phone:571-231-1402
Mailing Address - Fax:
Practice Address - Street 1:9300 DEWITT LOOP
Practice Address - Street 2:
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060
Practice Address - Country:US
Practice Address - Phone:571-231-1402
Practice Address - Fax:571-231-6641
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101254357207R00000X
MA270259207RE0101X
MA260392207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA-028OtherTRICARE/CHAMPUS
VA10113176OtherOPTIMA HEALTH
VA1457675050OtherUNITED HEALTHCARE
VAPAROtherCIGNA
VAPAROtherAETNA
VA496817OtherANHEM BC/BS
VA1457675050Medicaid
VAPAROtherMULTIPLAN
NC1457675050Medicaid
VA1457675050OtherVIRGINIA PREMIER HEALTH PLAN
VAPAROtherUSA MANAGED CARE
VA1457675050OtherCOVENTRY NETWORK
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherCORVEL
VAPAROtherMULTIPLAN
VA1457675050OtherUNITED HEALTHCARE