Provider Demographics
NPI:1689873796
Name:MCMULLEN, RAY EDWARD JR (PA-C)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:EDWARD
Last Name:MCMULLEN
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 JENNIFER DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT UNION
Mailing Address - State:PA
Mailing Address - Zip Code:17066-9111
Mailing Address - Country:US
Mailing Address - Phone:814-542-9645
Mailing Address - Fax:
Practice Address - Street 1:1120 PIKE ST
Practice Address - Street 2:SCI-SMITHFIELD
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-1117
Practice Address - Country:US
Practice Address - Phone:814-643-9342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA-000398-L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1009762OtherNCCPA
PAMA-000398-LOtherBUREAU OF PROFESSIONAL AN