Provider Demographics
NPI:1194765545
Name:MULROY ORTHOPAEDIC SURGERY & SPORTS MEDICINE, PC
Entity type:Organization
Organization Name:MULROY ORTHOPAEDIC SURGERY & SPORTS MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MULROY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-478-7135
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-0189
Mailing Address - Country:US
Mailing Address - Phone:508-478-7135
Mailing Address - Fax:508-473-7198
Practice Address - Street 1:321 FORTUNE BLVD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-1750
Practice Address - Country:US
Practice Address - Phone:508-478-7135
Practice Address - Fax:508-473-7198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MABLUE SHIELDOtherM18753
MA9733400Medicaid
MA3626845OtherAETNA
MA92156OtherFALLON HEALTH PLAN
MA698702OtherTUFTS HEALTH PLANS
MA9733400Medicaid