Provider Demographics
NPI:1245350248
Name:MURPHY, CHARLES S (PA)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:S
Last Name:MURPHY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 820933
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0933
Mailing Address - Country:US
Mailing Address - Phone:215-233-9700
Mailing Address - Fax:215-233-9710
Practice Address - Street 1:1722 BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:FLOURTOWN
Practice Address - State:PA
Practice Address - Zip Code:19031-1644
Practice Address - Country:US
Practice Address - Phone:215-233-9700
Practice Address - Fax:215-233-9710
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009341208G00000X
NY009341-1363AM0700X
PAMA-055936363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACD4829OtherTPI RAILROAD MEDICARE GROUP
PA1007278000OtherTPI MEDICAID GROUP ID
PA597586OtherTPI MEDICARE GROUP PTAN