Provider Demographics
NPI:1144773185
Name:MCMULLIN, MORGAN (PA)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:MCMULLIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2363
Mailing Address - Country:US
Mailing Address - Phone:203-234-2119
Mailing Address - Fax:203-239-3047
Practice Address - Street 1:31 BROADWAY
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2363
Practice Address - Country:US
Practice Address - Phone:203-234-1324
Practice Address - Fax:203-234-1611
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00965363A00000X
CT5213363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant