Provider Demographics
NPI:1285680157
Name:MULLIN, GUY SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:SCOTT
Last Name:MULLIN
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 1:409 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-8003
Mailing Address - Country:US
Mailing Address - Phone:215-860-3400
Mailing Address - Fax:215-860-8779
Practice Address - Street 1:409 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-8003
Practice Address - Country:US
Practice Address - Phone:215-860-3400
Practice Address - Fax:215-860-8779
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-058636L207W00000X
NJMA-64061207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1636160011OtherCIGNA
PA2128908OtherAETNA
233004475OtherUNITED HEALTHCARE
NJP00027690OtherRAILROAD MEDICARE
PA0025581000OtherKEYSTONE
PA180036195OtherRAILROAD MEDICARE
P1884042OtherOXFORD
NJ1636160010OtherCIGNA
NJ583196OtherAETNA
P1884042OtherOXFORD
NJP00027690OtherRAILROAD MEDICARE
NJ891371VSPMedicare PIN