Provider Demographics
NPI:1376208116
Name:MCMULLIN, DONALD EDWIN III
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:EDWIN
Last Name:MCMULLIN
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SIR LAWRENCE CT
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-1021
Mailing Address - Country:US
Mailing Address - Phone:856-905-7087
Mailing Address - Fax:
Practice Address - Street 1:1 SIR LAWRENCE CT
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-1021
Practice Address - Country:US
Practice Address - Phone:856-905-7087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-06
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty