Provider Demographics
NPI:1467499087
Name:MCNULTY, BRENDAN D (MD)
Entity type:Individual
Prefix:DR
First Name:BRENDAN
Middle Name:D
Last Name:MCNULTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:300 HEALTH PARK DR
Mailing Address - Street 2:SUITE 220, REX HEMATOLOGY ONCOLOGY ASSOCIATES OF GARNER
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-4685
Mailing Address - Country:US
Mailing Address - Phone:919-250-5955
Mailing Address - Fax:919-250-5954
Practice Address - Street 1:300 HEALTH PARK DR
Practice Address - Street 2:SUITE 220, REX HEMATOLOGY ONCOLOGY ASSOCIATES OF GARNER
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-4685
Practice Address - Country:US
Practice Address - Phone:919-250-5955
Practice Address - Fax:919-250-5954
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226196207R00000X
NC2013-01592207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCF513D555OtherMEDICARE PTAN