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General NPI Number Information
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NPI Number | 1700916475
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Entity Type | Individual
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Provider Name | BRYAN R MULLIN MD
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Gender | Male
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2204 WILBORN AVE HALIFAX REGIONAL MEDICAL CENTER
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City | SOUTH BOSTON
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State | VA
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Zip | 24592
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Country | US
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Telephone | 434-517-3229
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Fax |
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Provider Business Mailing Address
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Address Line | 3900 CONNECTICUT AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20008
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Country | US
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Telephone | 202-686-4455
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Fax |
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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 | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | 0101053735
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License Number State | VA
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