Provider Demographics
NPI:1770663312
Name:MULLEN, JAMES (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
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 1:174 S FREEPORT RD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-6145
Mailing Address - Country:US
Mailing Address - Phone:207-865-1819
Mailing Address - Fax:207-865-4535
Practice Address - Street 1:123 MEDICAL CENTER DR
Practice Address - Street 2:MID COAST HOSPITAL
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2652
Practice Address - Country:US
Practice Address - Phone:207-729-0181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME015374207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEAA48943OtherHARVARD PILGRIM
ME3844033OtherAETNA
ME8203907OtherCIGNA
ME061435OtherANTHEM
ME432026499Medicaid
ME1770663312OtherTRICARE
ME010453642OtherGREAT WEST/ONE HEALTH
MEP00302743OtherRR MEDICARE