NPIMap

Individual provider Active NPI

Wadia R Mulla, MD

  • Maternal & Fetal Medicine Physician
  • Dover, DE
National Provider Identifier
1710976642
Registry record updated Oct 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Maternal & Fetal Medicine PhysicianTaxonomy code 207VM0101X
License
C1-0004719 Issued in DE
Practice address
1060 S Governors Ave
Suite 102
Dover, DE 19904-6920
Phone
(302) 744-6220
Fax
(302) 734-8454
NPI assigned
Oct 13, 2005
Last updated
Oct 12, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2012

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Genetics (M.D.) Physician 207SG0201X MD043899L PA
Obstetrics & Gynecology Physician 207V00000X MD043899L PA
Maternal & Fetal Medicine Physician 207VM0101X MD043899L PA
Obstetrics Physician 207VX0000X C1-0004719 DE
Maternal & Fetal Medicine Physician 207VM0101X C1-0004719 DE Primary

Addresses

Primary practice location

1060 S Governors Ave
Suite 102
Dover, DE 19904-6920

Mailing address

640 S State St
742 Building
Dover, DE 19901-3530
Phone (302) 674-3970

Other identifiers 2

IdentifierTypeStateIssuer
001243406005MedicaidPA
001380ZA5HOtherGROUP MEMBER PTAN

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
I20050908000458 PA Practitioner - Obstetrics/Gynecology 9739111980 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Northeastern Ohio University College of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Temple Faculty Practice Plan IncGroup PAC ID 0345588711, 1,325 clinicians

Practice addresses (Care Compare)

3401 N Broad St
Philadelphia, PA 19140-5103
Phone (215) 707-5030

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD043899LPAMDClinical Genetics (M.D.) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Temple Faculty Practice Plan, Inc CurrentSince Mar 9, 2019 Accepting new patients
Temple Faculty Practice Plan Inc CurrentSince Mar 9, 2019 Accepting new patients
HR Physician Services CurrentSince Jul 1, 2020 Accepting new patients
HR Physician Services CurrentSince Jul 1, 2020 Accepting new patients
Temple Faculty Practice Plan Inc Current Accepting new patients
HR Physician Services Obstetrics & Gynecology Current Accepting new patients
Temple Faculty Practice Plan Inc Past Accepting new patients
Temple University Hospital, Inc Past Accepting new patients
Temple University Hospital, Inc Past Accepting new patients

Locations

1 Medical Center Blvd
Chester, PA 19013
Phone (610) 447-6666

515 Pennsylvania Ave
Ft Washington, PA 19034
Phone (215) 641-0700

1648 Huntingdon Pike
Meadowbrook, PA 19046
Phone (215) 938-3413

1650 Huntingdon Pike
Ste 107
Meadowbrook, PA 19046
Phone (215) 938-2990

1331 E Wyoming Ave
Philadelphia, PA 19124
Phone (215) 537-7400

3401 N Broad St
Philadelphia, PA 19140
Phone (215) 707-3807

Organizations & group practices 9

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

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": "1129161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350000000000",
    "number": "1710976642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 S STATE ST",
            "address_2": "742 BUILDING",
            "city": "DOVER",
            "state": "DE",
            "postal_code": "199013530",
            "telephone_number": "302-674-3970",
            "fax_number": "302-672-2350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 S GOVERNORS AVE",
            "address_2": "SUITE 102",
            "city": "DOVER",
            "state": "DE",
            "postal_code": "199046920",
            "telephone_number": "302-744-6220",
            "fax_number": "302-734-8454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLA",
        "first_name": "WADIA",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-13",
        "last_updated": "2012-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207SG0201X",
            "taxonomy_group": "",
            "desc": "Medical Genetics, Clinical Genetics (M.D.)",
            "state": "PA",
            "license": "MD043899L",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "PA",
            "license": "MD043899L",
            "primary": false
        },
        {
            "code": "207VM0101X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Maternal & Fetal Medicine",
            "state": "PA",
            "license": "MD043899L",
            "primary": false
        },
        {
            "code": "207VX0000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": "DE",
            "license": "C1-0004719",
            "primary": false
        },
        {
            "code": "207VM0101X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Maternal & Fetal Medicine",
            "state": "DE",
            "license": "C1-0004719",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001243406005",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEMBER PTAN",
            "identifier": "001380ZA5H",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dover, DE

Sources for this page

Verify at the official NPI Registry.