Provider Demographics
NPI:1245435940
Name:MULLEN, BRENDAN THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:BRENDAN
Middle Name:THOMAS
Last Name:MULLEN
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 1:320 E NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4756
Mailing Address - Country:US
Mailing Address - Phone:412-359-2459
Mailing Address - Fax:412-359-8233
Practice Address - Street 1:320 E NORTH AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4756
Practice Address - Country:US
Practice Address - Phone:412-359-2459
Practice Address - Fax:412-359-8233
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0994482085R0202X
PAMD4453582085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH204881619259OtherCARESOURCE
OH684692OtherWELLCARE
OHP01085366OtherRAILROAD MEDICARE
OH35.099448OtherLICENSE
OH0066775Medicaid
OH35.099448OtherLICENSE