Provider Demographics
NPI:1104148527
Name:MULLAN, CHARLES PATRICK (MB BCH)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:PATRICK
Last Name:MULLAN
Suffix:
Gender:M
Credentials:MB BCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 BROOKLINE AVE
Mailing Address - Street 2:APT 13G
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5408
Mailing Address - Country:US
Mailing Address - Phone:617-947-3082
Mailing Address - Fax:
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY, BIDMC
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-947-3082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2352252085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology