Individual
WILLIAM J. MULLALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
111 GROSSMAN DR, NEUROLOGY, BRAINTREE, MA 02184-4997
(781) 849-2265
(781) 849-2274
Mailing address
147 MILK ST, PROVIDER ENROLLMENT 9TH FLOOR, BOSTON, MA 02109-4806
(617) 421-6540
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
46261
MA
2084N0400X
Neurology Physician
Primary
46261
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0014880
NEIGHBORHOOD HEALTH PLAN
MA
01
—
046261
TUFTS HEALTH PLAN
MA
01
—
111404
HARVARD PILGRIM
MA
05
—
3179591
—
MA
01
—
7011385-002
CIGNA
MA
01
—
J12153
BLUE CROSS
MA
01
—
P00086706
MEDICARE RAILROAD
MA
Enumeration date
09/29/2006
Last updated
06/07/2011
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