NPIMap

Individual provider Active NPI

Michael Thomas Mullen Jr., MD

  • Vascular Neurology Physician
  • Philadelphia, PA
National Provider Identifier
1306901533
Registry record updated Jun 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Neurology PhysicianTaxonomy code 2084V0102X
License
MD437409 Issued in PA
Practice address
3400 Civic Center Blvd
2ND Floor South Pavillion
Philadelphia, PA 19104-5127
Phone
(215) 662-3606
Fax
(215) 349-5579
NPI assigned
Dec 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Neurology Physician 2084V0102X MD437409 PA Primary
Neurology Physician 2084N0400X MD437409 PA

Addresses

Primary practice location

3400 Civic Center Blvd
2ND Floor South Pavillion
Philadelphia, PA 19104-5127

Mailing address

3400 Civic Center Blvd
2ND Floor South Pavillion
Philadelphia, PA 19104-5127
Phone (215) 662-3606

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NJ2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100908000530 PA Practitioner - NeurologyPractitioner - Psychiatry 9032233424 Reassigns benefits to 2 organizations
I20210126000152 NJ Practitioner - Neurology 9032233424 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NeurologyAlso: Psychiatry
Education
Perelman School of Med at the University of Pennsylvania, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Temple Faculty Practice Plan IncGroup PAC ID 0345588711, 1,325 clinicians

Practice addresses (Care Compare)

3401 N Broad St
Philadelphia, PA 19140-5103
Phone (215) 707-5030

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD437409PAMDVascular Neurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Temple Faculty Practice Plan Inc CurrentSince Aug 16, 2021 Accepting new patients
University of Penn-Medical Group Current Accepting new patients
Clinical Health Care Associates of New Jersey, PC Current Accepting new patients
Clinical Health Care Associates of New Jersey, PC CurrentSince Oct 23, 2020 Accepting new patients
University of Penn - Medical Group CurrentSince Feb 1, 2015 Accepting new patients
University of Penn-Medical Group CurrentSince Feb 1, 2015 Accepting new patients
Temple Faculty Practice Plan Inc Current Accepting new patients
Clinical Health Care Associates of New Jersey, P.C. CurrentSince Oct 23, 2020 Accepting new patients
Temple Faculty Practice Plan Inc CurrentSince Aug 16, 2021 Accepting new patients
Temple University Hospital, Inc Past Accepting new patients
Temple Faculty Practice Plan Inc Past Accepting new patients

Locations

1600 Haddon Ave
Camden, NJ 08103
Phone (609) 757-3500

3205 Fire Rd
Egg Hbr Twp, NJ 08234
Phone (609) 407-1113

515 Pennsylvania Ave
Ft Washington, PA 19034
Phone (215) 641-0700

2450 W Hunting Park Ave
Philadelphia, PA 19129
Phone (215) 707-2433

3401 N Broad St
Philadelphia, PA 19140
Phone (215) 707-3807

3624 Market St
Fl 2
Philadelphia, PA 19104
Phone (215) 615-3669

3400 Civic Center Blvd
Fl 2
Philadelphia, PA 19104

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1434499200000",
    "number": "1306901533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 CIVIC CENTER BLVD",
            "address_2": "2ND FLOOR SOUTH PAVILLION",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191045127",
            "telephone_number": "215-662-3606",
            "fax_number": "215-349-5579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 CIVIC CENTER BLVD",
            "address_2": "2ND FLOOR SOUTH PAVILLION",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191045127",
            "telephone_number": "215-662-3606",
            "fax_number": "215-349-5579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLEN",
        "first_name": "MICHAEL",
        "middle_name": "THOMAS",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-27",
        "last_updated": "2015-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084V0102X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Vascular Neurology",
            "state": "PA",
            "license": "MD437409",
            "primary": true
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "PA",
            "license": "MD437409",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.