Individual
KEVIN PATRICK MCMULLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
557 BROOKDALE DR, STATESVILLE, NC 28677-4107
(704) 878-4615
(704) 878-7193
Mailing address
PO BOX 1828, STATESVILLE, NC 28687-1828
(704) 878-4615
(704) 878-7193
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
9900941
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000746372
ANTHEM
IN
01
—
000000990588
ANTHEM PIN
IN
05
—
10001251
—
VA
01
—
1333U
BCBS
NC
05
—
2004948000
—
WV
05
—
201037980
—
IN
01
—
7957688
AETNA
—
01
—
802872
PARTNERS
NC
05
—
891333U
—
NC
01
—
C6010
MEDCOST
NC
01
—
P01420734
RAILROAD MEDICARE
IN
05
—
Q0094C
—
SC
Enumeration date
11/16/2005
Last updated
12/11/2024
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