Active NPI
Bryan R Mullin, MD
- Anatomic Pathology Physician
- South Boston, VA
National Provider Identifier
1700916475
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology Physician
- License
- 0101053735
- Practice address
- 2204 Wilborn Ave
Halifax Regional Medical Center
South Boston, VA 24592 - Phone
- (434) 517-3229
- NPI assigned
- Mar 6, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology Physician | 207ZP0101X | 0101053735 | VA | Primary |
Addresses
Primary practice location
2204 Wilborn Ave
Halifax Regional Medical Center
South Boston, VA 24592
Mailing address
3900 Connecticut Ave NW
Washington, DC 20008
Phone (202) 686-4455
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0101053735 | VA | MD | Anatomic Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1700916475",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3900 CONNECTICUT AVE NW",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "20008",
"telephone_number": "202-686-4455"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2204 WILBORN AVE",
"address_2": "HALIFAX REGIONAL MEDICAL CENTER",
"city": "SOUTH BOSTON",
"state": "VA",
"postal_code": "24592",
"telephone_number": "434-517-3229"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MULLIN",
"first_name": "BRYAN",
"middle_name": "R",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0101X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology",
"state": "VA",
"license": "0101053735",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Boston, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.