Provider Demographics
NPI:1235553546
Name:MULLANE, PATRICK CONNOR
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:CONNOR
Last Name:MULLANE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 ASHLEY AVE DEPT OF
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-9080
Mailing Address - Country:US
Mailing Address - Phone:850-274-9116
Mailing Address - Fax:
Practice Address - Street 1:171 ASHLEY AVE DEPT OF
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-9080
Practice Address - Country:US
Practice Address - Phone:850-274-9116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC92308207ZP0102X
390200000X
GA103992207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program