Provider Demographics
NPI:1518964790
Name:MULLIN, BRADFORD B (MD)
Entity Type:Individual
Prefix:
First Name:BRADFORD
Middle Name:B
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 1:955 EASTWIND DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-3376
Mailing Address - Country:US
Mailing Address - Phone:614-268-9561
Mailing Address - Fax:614-268-7849
Practice Address - Street 1:955 EASTWIND DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-3376
Practice Address - Country:US
Practice Address - Phone:614-268-9561
Practice Address - Fax:614-268-7849
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35059100M207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH649946OtherAETNA PIN
OH1789438007OtherCIGNA HEALTHCARE PIN
OH0979204Medicaid
OH000000006771OtherANTHEM PIN
OH600102OtherUNITED HEALTHCARE PIN
KY64094782Medicaid
OH310874776029OtherCARESOURCE PIN
KY64094782Medicaid
OH140003150Medicare PIN
OH649946OtherAETNA PIN
OHMU0760331Medicare PIN