Provider Demographics
NPI:1659370807
Name:MULL, RICHARD T (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:T
Last Name:MULL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:200 NEW HOPE RD
Mailing Address - Street 2:PO BOX 1559
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2155
Mailing Address - Country:US
Mailing Address - Phone:304-487-1076
Mailing Address - Fax:304-425-9499
Practice Address - Street 1:200 NEW HOPE RD
Practice Address - Street 2:QUAIL VALLEY MEDICAL CENTER NO 7
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2155
Practice Address - Country:US
Practice Address - Phone:304-487-1076
Practice Address - Fax:304-425-9499
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV154842085R0202X, 2085B0100X, 2085N0700X, 2085N0904X, 2085P0229X, 2085R0204X, 2085R0205X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Not Answered2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Not Answered2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Not Answered2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Not Answered2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Not Answered2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Not Answered2085R0205XAllopathic & Osteopathic PhysiciansRadiologyRadiological Physics
Not Answered2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2004678000Medicaid
B09488Medicare UPIN
MU4109121Medicare ID - Type Unspecified