Provider Demographics
NPI:1750323960
Name:MULLEN, MATTHEW PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:PAUL
Last Name:MULLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 ROGERS RD
Mailing Address - Street 2:#300
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-9306
Mailing Address - Country:US
Mailing Address - Phone:919-570-2000
Mailing Address - Fax:919-570-2001
Practice Address - Street 1:700 US 1 HWY STE 100
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27596
Practice Address - Country:US
Practice Address - Phone:919-570-2000
Practice Address - Fax:919-570-2001
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96 00073174400000X
NC9600073207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No174400000XOther Service ProvidersSpecialist