Basic Information
| Provider Information | |||||||||
| NPI: | 1609877562 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCMULLIN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | DEE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 856 J CLYDE MORRIS BLVD | ||||||||
| Address2: | STE A | ||||||||
| City: | NEWPORT NEWS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236011318 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 10510 JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | NEWPORT NEWS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236013102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575944720 | ||||||||
| FaxNumber: | 7575944735 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2005 | ||||||||
| LastUpdateDate: | 01/30/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | C5942 | AR | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | MD0000016225 | TN | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 0101033794 | VA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.