Provider Demographics
NPI:1740428317
Name:MULLIN, KATHLEEN B (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:B
Last Name:MULLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30 BUXTON FARM RD STE 230
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-1206
Mailing Address - Country:US
Mailing Address - Phone:203-914-1900
Mailing Address - Fax:203-914-1903
Practice Address - Street 1:30 BUXTON FARM RD STE 230
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1206
Practice Address - Country:US
Practice Address - Phone:203-914-1900
Practice Address - Fax:203-914-1903
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2504482084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology