MEDICARE: DR. MARK JAY MULLEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD0402071E	PA

General Provider Information

NPI Number	:	1679581870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK JAY MULLEN MD

Provider Business Mailing Address
First Line	:	1648 HUNTINGDON PIKE
Second Line	:	MEDICAL STAFF OFFICE 1ST FLR
City	:	MEADOWBROOK
State	:	PA
Zip	:	19046-8001
Country	:	US
Telephone Number	:	215-938-3450
Fax Number	:	215-938-3829

Provider Business Practice Location Address
First Line	:	23 BUSTLETON PIKE
Second Line	:	SUITE 200
City	:	FEASTERVILLE TREVOSE
State	:	PA
Zip	:	19053-6446
Country	:	US
Telephone Number	:	215-464-0770
Fax Number	:	267-579-0720

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	07/01/2021

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