Provider Demographics
NPI:1952044042
Name:MCCULLEN, ANDREW JOHN (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JOHN
Last Name:MCCULLEN
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 1:13158 APPLEGROVE LN
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-3943
Mailing Address - Country:US
Mailing Address - Phone:703-403-2652
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE # JJ24
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-6202
Practice Address - Country:US
Practice Address - Phone:703-403-2652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-16
Last Update Date:2023-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT225137207R00000X
OH57.2551122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine