Provider Demographics
NPI:1194927509
Name:MULHEARN, MEREDITH JANE (MD)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:JANE
Last Name:MULHEARN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:
Other - Last Name:MULHEARN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:133 BROOKLINE AVE
Mailing Address - Street 2:CARDIOLOGY DEPARTMENT
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-3904
Mailing Address - Country:US
Mailing Address - Phone:617-421-6050
Mailing Address - Fax:617-421-6083
Practice Address - Street 1:133 BROOKLINE AVE
Practice Address - Street 2:CARDIOLOGY DEPARTMENT
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-3904
Practice Address - Country:US
Practice Address - Phone:617-421-6050
Practice Address - Fax:617-421-6083
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP01210207RC0000X
MA229694207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110089306AMedicaid
MA110089306AMedicaid