Provider Demographics
NPI:1447344049
Name:MULDOON, RAYMOND JOSEPH (NP)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:JOSEPH
Last Name:MULDOON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:750 EAST ADAMS STREET
Mailing Address - Street 2:ROOM 1702, UNIVERSITY HOSPITAL
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210
Mailing Address - Country:US
Mailing Address - Phone:315-464-9089
Mailing Address - Fax:315-464-5632
Practice Address - Street 1:750 EAST ADAMS STREET
Practice Address - Street 2:ROOM 1702, UNIVERSITY HOSPITAL
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-464-9089
Practice Address - Fax:315-464-5632
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF400813-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health