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General NPI Number Information
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NPI Number | 1366827826
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Entity Type | Organization
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Legal Business Name | MICHAEL P. MCMULLEN M.D. P.C.
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Dates
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Enumeration Date | 07/27/2015
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Last Update Date | 07/27/2015
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Provider Practice Location Address
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Address Line | 505 BEAHAN RD
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City | ROCHESTER
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State | NY
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Zip | 14624-3403
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Country | US
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Telephone | 585-426-1470
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Fax | 585-426-6510
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Provider Business Mailing Address
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Address Line | 505 BEAHAN RD
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City | ROCHESTER
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State | NY
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Zip | 14624-3403
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Country | US
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Telephone | 585-426-1470
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Fax | 585-426-6510
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. CHRISTINE MARY MCMULLEN
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Credential | R.N.
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Telephone | 585-426-1470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 163485
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License Number State | NY
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