Provider Demographics
NPI:1073252342
Name:MURPHY, MADELINE (PA)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:MURPHY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 HAZARD AVE
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4520
Mailing Address - Country:US
Mailing Address - Phone:860-749-2022
Mailing Address - Fax:860-763-1398
Practice Address - Street 1:170 HAZARD AVE
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4520
Practice Address - Country:US
Practice Address - Phone:860-749-2022
Practice Address - Fax:860-763-1398
Is Sole Proprietor?:No
Enumeration Date:2022-06-03
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CT6052363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant