Provider Demographics
NPI:1770501082
Name:MCMULLEN, SCOTT M (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:M
Last Name:MCMULLEN
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 1:3200 SYCAMORE CT STE 1B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-1545
Mailing Address - Country:US
Mailing Address - Phone:812-378-9027
Mailing Address - Fax:812-378-1014
Practice Address - Street 1:3200 SYCAMORE CT STE 1B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-1545
Practice Address - Country:US
Practice Address - Phone:812-378-9027
Practice Address - Fax:812-378-1014
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042786207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200006500Medicaid
IN000000087835OtherANTHEM PIN #
IN000000087835OtherANTHEM PIN #
IN054620KMedicare PIN