Provider Demographics
NPI:1770678351
Name:MCMULLEN, JONATHAN (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:MCMULLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:344 ROLLING HILL RD
Mailing Address - Street 2:STE 102
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6865
Mailing Address - Country:US
Mailing Address - Phone:704-464-4439
Mailing Address - Fax:704-664-8802
Practice Address - Street 1:340 RIVERWOOD RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8896
Practice Address - Country:US
Practice Address - Phone:704-928-5174
Practice Address - Fax:704-662-6946
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC01754207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2051987Medicare PIN
NCG27119Medicare UPIN