Provider Demographics
NPI:1124111273
Name:MULLIGAN, ERIKA A (DO)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:A
Last Name:MULLIGAN
Suffix:
Gender:F
Credentials:DO
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 8792
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8792
Mailing Address - Country:US
Mailing Address - Phone:440-286-9588
Mailing Address - Fax:440-286-2837
Practice Address - Street 1:11110 KINSMAN RD UNIT 2
Practice Address - Street 2:
Practice Address - City:NEWBURY
Practice Address - State:OH
Practice Address - Zip Code:44065-8604
Practice Address - Country:US
Practice Address - Phone:440-564-7060
Practice Address - Fax:216-201-7945
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006728207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2075981Medicaid
OH2075981Medicaid
OH0858104Medicare PIN