Provider Demographics
NPI:1700911153
Name:MULVANEY, SEAN WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:WILLIAM
Last Name:MULVANEY
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:ROSM ANNAPOLIS
Mailing Address - Street 2:116 DEFENSE HIGHWAY SUITE 203
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401
Mailing Address - Country:US
Mailing Address - Phone:410-505-0530
Mailing Address - Fax:410-505-0531
Practice Address - Street 1:11300 ROCKVILLE PIKE STE 615
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3033
Practice Address - Country:US
Practice Address - Phone:202-681-7671
Practice Address - Fax:844-681-7671
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055367A207Q00000X, 207QS0010X
MDD0070210207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine