Provider Demographics
NPI:1861410193
Name:MURPHY, MARY ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANNE
Last Name:MURPHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16000 PEARL RD
Mailing Address - Street 2:#15
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-6082
Mailing Address - Country:US
Mailing Address - Phone:440-846-7481
Mailing Address - Fax:440-846-3518
Practice Address - Street 1:16000 PEARL RD
Practice Address - Street 2:#15
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-6082
Practice Address - Country:US
Practice Address - Phone:440-846-7481
Practice Address - Fax:440-846-3518
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35051943174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0593620Medicaid
OH0593620Medicaid