Provider Demographics
NPI:1831153865
Name:MULLEN, PATRICK DENNIS (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:DENNIS
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:PO BOX 149
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-0149
Mailing Address - Country:US
Mailing Address - Phone:919-496-2124
Mailing Address - Fax:
Practice Address - Street 1:216 N BICKETT BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-2473
Practice Address - Country:US
Practice Address - Phone:919-496-2124
Practice Address - Fax:919-496-3002
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8961368Medicaid
NC2221221Medicare ID - Type Unspecified
NC8961368Medicaid