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General NPI Number Information
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NPI Number | 1457386179
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Entity Type | Individual
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Provider Name | MICHAEL JOHN MULLEN MD
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Gender | Male
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 01/25/2021
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Provider Practice Location Address
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Address Line | 2645 N 3RD ST
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City | HARRISBURG
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State | PA
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Zip | 17110-2034
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Country | US
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Telephone | 717-782-4700
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Fax | 717-782-4710
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Provider Business Mailing Address
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Address Line | 409 S 2ND ST STE 2F
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City | HARRISBURG
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State | PA
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Zip | 17104-1612
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Country | US
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Telephone | 717-782-4700
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Fax | 717-782-4710
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | D0058294
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD446480
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License Number State | PA
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