NPIMap

Individual provider Active NPI

Joseph P. Mulligan, D.M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Philadelphia, PA
National Provider Identifier
1225045594
Registry record updated Jul 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
DS030297L Issued in PA
Practice address
100 E Lehigh Ave
Om2
Philadelphia, PA 19125
Phone
(215) 707-3613
Fax
(215) 707-5404
NPI assigned
Aug 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X DI02271900 NJ
Oral and Maxillofacial Surgery (Dentist) 1223S0112X DS030297L PA Primary

Addresses

Primary practice location

100 E Lehigh Ave
Om2
Philadelphia, PA 19125

Mailing address

1 Federal St # 200
Camden, NJ 08103-1088
Phone (856) 356-4924

Other practice location 1

2 Plaza Dr Ste 203
Sewell, NJ 08080
Phone (856) 270-4100

Other practice location 2

2 Plaza Dr Ste 203
Sewell, NJ 08080
Phone (856) 270-4100

Other identifiers 1

IdentifierTypeStateIssuer
0055824MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050315000739 PA Practitioner - Oral SurgeryPractitioner - Maxillofacial Surgery 6507842671 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Oral SurgeryAlso: Maxillofacial Surgery
Education
Temple University School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Delaware Valley Maxillofacial and Oral Surgery LLCGroup PAC ID 3072567197, 3 clinicians

Practice addresses (Care Compare)

100 E Lehigh Ave
Southeastern PA Oral Surg
Philadelphia, PA 19125-1012
Phone (215) 707-3613

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DI02271900NJMDOral and Maxillofacial Surgery (Dentist)

Practice roles

OrganizationSpecialtyStatusNew patients
Maxilla LLC Oral and Maxillofacial Surgery PastSince Oct 22, 2023 Accepting new patients
Penna Oral & Maxillofacial Surgery Oral and Maxillofacial Surgery PastSince Jan 1, 2002 Accepting new patients
Siouxland Oral Surgery Oral and Maxillofacial Surgery Past Accepting new patients

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563926400000",
    "number": "1225045594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 FEDERAL ST # 200",
            "city": "CAMDEN",
            "state": "NJ",
            "postal_code": "081031088",
            "telephone_number": "856-356-4924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E LEHIGH AVE",
            "address_2": "OM2",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19125",
            "telephone_number": "215-707-3613",
            "fax_number": "215-707-5404"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2 Plaza Dr Ste 203",
            "address_purpose": "LOCATION",
            "city": "Sewell",
            "state": "NJ",
            "postal_code": "08080",
            "country_code": "US",
            "telephone_number": "856-270-4100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2 Plaza Dr Ste 203",
            "address_purpose": "LOCATION",
            "city": "Sewell",
            "state": "NJ",
            "postal_code": "08080",
            "country_code": "US",
            "telephone_number": "856-270-4100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MULLIGAN",
        "first_name": "JOSEPH",
        "middle_name": "P.",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2019-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NJ",
            "license": "DI02271900",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "PA",
            "license": "DS030297L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0055824",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.