Individual
JEFFREY MULLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3200 MACCORKLE AVE SE, CHARLESTON, WV 25304-1227
(304) 388-4170
Mailing address
3100 MACCORKLE AVE SE, STE 203, CHARLESTON, WV 25304-1228
(304) 388-1724
(304) 388-1721
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2010
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001884657
WV BCBS
WV
01
—
1068868
WV DWC
WV
05
—
3810006147
—
WV
Enumeration date
08/20/2006
Last updated
01/03/2017
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