Individual
MR. MUKUL MALLICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1380 N PARHAM RD, RICHMOND, VA 23229-5742
(048) 821-0010
(804) 821-0011
Mailing address
4014 CARRIE MILL XING, GLEN ALLEN, VA 23059-8057
(480) 330-8920
(804) 821-0011
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110-005354
VA
Other
Enumeration date
05/06/2016
Last updated
02/04/2025
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