Provider Demographics
NPI:1881718526
Name:MULCAHY, DIANE (ANP)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:MULCAHY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 FAUNCE CORNER MALL ROAD
Mailing Address - Street 2:DERMATOLOGY SERVICES INC
Mailing Address - City:NO DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747
Mailing Address - Country:US
Mailing Address - Phone:508-993-7601
Mailing Address - Fax:508-997-0523
Practice Address - Street 1:145 FAUNCE CORNER MALL ROAD
Practice Address - Street 2:DERMATOLOGY SERVICES INC
Practice Address - City:NO DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747
Practice Address - Country:US
Practice Address - Phone:508-993-7601
Practice Address - Fax:508-997-0523
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA138592363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP2534OtherBLUE SHIELD
P20345Medicare UPIN
MANP2534Medicare ID - Type Unspecified