Provider Demographics
NPI:1144255373
Name:MULLEN, WILLIAM R (PA-C)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:MULLEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2551
Mailing Address - Country:US
Mailing Address - Phone:603-224-3368
Mailing Address - Fax:603-228-7268
Practice Address - Street 1:264 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2551
Practice Address - Country:US
Practice Address - Phone:603-224-3368
Practice Address - Fax:603-228-7268
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0507363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30333016Medicaid
NH1861558645OtherNSC PROVIDER LOCATION #
NH1841320207OtherNSC PROVIDER LOCATION #
NH1922164797OtherNSC PROVIDER LOCATION #
NH1881772242OtherNSC PROVIDER LOCATION #
NH1932256914OtherNSC PROVIDER LOCATION #
1801952692OtherNSC PROVIDER LOCATION #
AP2228Medicare PIN
NH30333016Medicaid
NH1861558645OtherNSC PROVIDER LOCATION #
NH1881772242OtherNSC PROVIDER LOCATION #
Q22147Medicare UPIN
NH0132510003Medicare NSC
NH0132510001Medicare NSC