Active NPI
Katherine Grace Mulligan, M.D.
- Internal Medicine Physician
- Lebanon, PA
National Provider Identifier
1053417444
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- NC 9500415
- Practice address
- 1700 S Lincoln Ave
Lebanon, PA 17042-7529 - Phone
- (717) 272-6621
- NPI assigned
- Sep 15, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | NC 9500415 | NC | |
| Internal Medicine Physician | 207R00000X | NC 9500415 | NC | Primary |
Addresses
Primary practice location
1700 S Lincoln Ave
Lebanon, PA 17042-7529
Mailing address
140 Robin LN
Apt Q6
Hummelstown, PA 17036-8242
Phone (717) 566-4373
Other practice location 1
EAATS Medical Clinic
Fort Indiantown Gap
Annville, PA 17028
Phone (717) 861-9175
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NC 9500415 | NC | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158278400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713484800000",
"number": "1053417444",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "140 ROBIN LN",
"address_2": "APT Q6",
"city": "HUMMELSTOWN",
"state": "PA",
"postal_code": "170368242",
"telephone_number": "717-566-4373"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1700 S LINCOLN AVE",
"city": "LEBANON",
"state": "PA",
"postal_code": "170427529",
"telephone_number": "717-272-6621"
}
],
"practiceLocations": [
{
"address_1": "EAATS Medical Clinic",
"address_2": "Fort Indiantown Gap",
"address_purpose": "LOCATION",
"city": "Annville",
"state": "PA",
"postal_code": "17028",
"country_code": "US",
"telephone_number": "717-861-9175",
"fax_number": "717-861-8235",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MULLIGAN",
"first_name": "KATHERINE",
"middle_name": "GRACE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-15",
"last_updated": "2024-04-19",
"certification_date": "2024-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NC",
"license": "NC 9500415",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NC",
"license": "NC 9500415",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lebanon, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.