Provider Demographics
NPI:1093247868
Name:MURPHY, KEENAN
Entity Type:Individual
Prefix:
First Name:KEENAN
Middle Name:
Last Name:MURPHY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4855 S PALMER RD RM 7131
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-5663
Mailing Address - Country:US
Mailing Address - Phone:301-400-2930
Mailing Address - Fax:301-400-2930
Practice Address - Street 1:4855 S PALMER RD RM 7131
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-4504
Practice Address - Country:US
Practice Address - Phone:301-295-4503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101265030208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice