Individual
WADIA R MULLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1060 S GOVERNORS AVE, SUITE 102, DOVER, DE 19904-6920
(302) 744-6220
(302) 734-8454
Mailing address
640 S STATE ST, 742 BUILDING, DOVER, DE 19901-3530
(302) 674-3970
(302) 672-2350
Taxonomy
Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
MD043899L
PA
207V00000X
Obstetrics & Gynecology Physician
MD043899L
PA
207VM0101X
Maternal & Fetal Medicine Physician
Primary
C1-0004719
DE
207VM0101X
Maternal & Fetal Medicine Physician
MD043899L
PA
207VX0000X
Obstetrics Physician
C1-0004719
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001243406005
—
PA
01
—
001380ZA5H
GROUP MEMBER PTAN
—
Enumeration date
10/13/2005
Last updated
10/12/2012
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