Provider Demographics
NPI:1972066611
Name:MCNULTY, STEPHEN BARRETT (DO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:BARRETT
Last Name:MCNULTY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 5TH ST SE STE G
Mailing Address - Street 2:
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-4225
Mailing Address - Country:US
Mailing Address - Phone:330-745-3151
Mailing Address - Fax:
Practice Address - Street 1:101 5TH ST SE STE G
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-4225
Practice Address - Country:US
Practice Address - Phone:330-745-3151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.015577207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000000Medicaid