Provider Demographics
NPI:1063402105
Name:MULHERN, JEFFREY G (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:G
Last Name:MULHERN
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:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-0366
Mailing Address - Country:US
Mailing Address - Phone:413-733-0010
Mailing Address - Fax:413-930-2108
Practice Address - Street 1:134 CAPITAL DR STE E
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-1320
Practice Address - Country:US
Practice Address - Phone:413-733-0010
Practice Address - Fax:413-930-2108
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035565207RN0300X
MA55789207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003089150Medicaid
MA110048323AMedicaid
A14175Medicare UPIN
CT390000113Medicare PIN
MAJ07660Medicare PIN
CT003089150Medicaid
MAJ07660Medicare PIN
CT003089150Medicaid