MEDICARE: JOSEPH CHARLES MULLEN

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1629939996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH CHARLES MULLEN

Provider Business Mailing Address
First Line	:	1542 SAINT LEGER PL
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45207-1419
Country	:	US
Telephone Number	:	330-685-0596
Fax Number	:

Provider Business Practice Location Address
First Line	:	1542 SAINT LEGER PL
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45207-1419
Country	:	US
Telephone Number	:	330-685-0596
Fax Number	:

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

Provider Enumeration Date	:	11/18/2025
Last Update Date	:	05/26/2026

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