Provider Demographics
NPI:1033115696
Name:MURTY, INDUBALA M (MD)
Entity Type:Individual
Prefix:
First Name:INDUBALA
Middle Name:M
Last Name:MURTY
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 1:401 MARKET ST STE 200
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2846
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 MARKET ST STE 200
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2846
Practice Address - Country:US
Practice Address - Phone:740-282-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041331E207R00000X
WV15463207R00000X
OH35.057424207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0726781Medicaid
WV3810007536Medicaid
OH110214543OtherRR MEDICARE
OH9285544Medicare PIN
OH0726781Medicaid
OH0626285Medicare PIN
D97878Medicare UPIN
OHH051460Medicare PIN