Provider Demographics
NPI:1073575429
Name:MCMULLEN, MICHAEL PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PATRICK
Last Name:MCMULLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 MELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4510
Mailing Address - Country:US
Mailing Address - Phone:585-453-0419
Mailing Address - Fax:585-453-0419
Practice Address - Street 1:505 BEAHAN RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-3403
Practice Address - Country:US
Practice Address - Phone:585-426-1470
Practice Address - Fax:585-426-6510
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163485207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1573OtherBLUE SHIELD PROVIDER #
NY01089129Medicaid
NY5008322OtherAETNA PROVIDER NUMBER
NYBF101110OtherPREFERRED CARE PROVIDER
NMP010163485OtherBC/BS PAYEE ID
NYMM31444BOtherRAILROAD MEDICARE #
NY000911507002OtherHEALTH NOW PROVIDER #
NYD01857Medicare UPIN