Provider Demographics
NPI:1003014192
Name:JOHN MURPHY DPM, LLC
Entity Type:Organization
Organization Name:JOHN MURPHY DPM, LLC
Other - Org Name:MARYLAND PODIATRY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-992-8504
Mailing Address - Street 1:3460 ELLICOTT CENTER DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4173
Mailing Address - Country:US
Mailing Address - Phone:410-992-8504
Mailing Address - Fax:410-992-8509
Practice Address - Street 1:3460 ELLICOTT CENTER DR
Practice Address - Street 2:SUITE 103
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4173
Practice Address - Country:US
Practice Address - Phone:410-992-8504
Practice Address - Fax:410-992-8509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP0002786213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD134302500Medicaid
MD949MMedicare PIN
MD134302500Medicaid