MEDICARE: DR. MICHAEL PATRICK MCMULLEN M.D.

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	207Q00000X	Family Medicine Physician	163485	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	MM31444B	OTHER	NY	RAILROAD MEDICARE #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1573	OTHER	NY	BLUE SHIELD PROVIDER #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	5008322	OTHER	NY	AETNA PROVIDER NUMBER
4	BF101110	OTHER	NY	PREFERRED CARE PROVIDER
5	P010163485	OTHER	NM	BC/BS PAYEE ID
7	000911507002	OTHER	NY	HEALTH NOW PROVIDER #

General Provider Information

NPI Number	:	1073575429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL PATRICK MCMULLEN M.D.

Provider Business Mailing Address
First Line	:	349 MELWOOD DR
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-4510
Country	:	US
Telephone Number	:	585-453-0419
Fax Number	:	585-453-0419

Provider Business Practice Location Address
First Line	:	505 BEAHAN RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14624-3403
Country	:	US
Telephone Number	:	585-426-1470
Fax Number	:	585-426-6510

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

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	11/20/2009

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Directions to “ DR. MICHAEL PATRICK MCMULLEN M.D.” Practice Location

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