Provider Demographics
NPI:1073740353
Name:SQUIBB, ANNA MURLEY (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MURLEY
Last Name:SQUIBB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2145 N FAIRFIELD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-2783
Mailing Address - Country:US
Mailing Address - Phone:937-558-3900
Mailing Address - Fax:937-558-3999
Practice Address - Street 1:6438 WILMINGTON PIKE
Practice Address - Street 2:STE 100
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-7021
Practice Address - Country:US
Practice Address - Phone:614-566-0950
Practice Address - Fax:614-566-0766
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.098163207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0065002Medicaid
OHH121241Medicare PIN