MEDICARE: DR. MATTHEW PAUL MULLEN 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	174400000X	Specialist	96 00073	NC
2	207P00000X	Emergency Medicine Physician	9600073	NC

General Provider Information

NPI Number	:	1750323960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW PAUL MULLEN MD

Provider Business Mailing Address
First Line	:	3650 ROGERS RD
Second Line	:	#300
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-9306
Country	:	US
Telephone Number	:	919-570-2000
Fax Number	:	919-570-2001

Provider Business Practice Location Address
First Line	:	700 US 1 HWY STE 100
Second Line	:
City	:	YOUNGSVILLE
State	:	NC
Zip	:	27596
Country	:	US
Telephone Number	:	919-570-2000
Fax Number	:	919-570-2001

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	09/02/2022

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