MEDICARE: KEVIN PATRICK MCMULLEN 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	2085R0001X	Radiation Oncology Physician	9900941	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P01420734	OTHER	IN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	7957688	OTHER		AETNA
5	802872	OTHER	NC	PARTNERS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	1333U	OTHER	NC	BCBS
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	000000746372	OTHER	IN	ANTHEM
11	000000990588	OTHER	IN	ANTHEM PIN
12	C6010	OTHER	NC	MEDCOST

General Provider Information

NPI Number	:	1093797045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN PATRICK MCMULLEN MD

Provider Business Mailing Address
First Line	:	PO BOX 1828
Second Line	:
City	:	STATESVILLE
State	:	NC
Zip	:	28687-1828
Country	:	US
Telephone Number	:	704-878-4615
Fax Number	:	704-878-7193

Provider Business Practice Location Address
First Line	:	557 BROOKDALE DR
Second Line	:
City	:	STATESVILLE
State	:	NC
Zip	:	28677-4107
Country	:	US
Telephone Number	:	704-878-4615
Fax Number	:	704-878-7193

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

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	12/11/2024

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