Provider Demographics
NPI:1235434671
Name:RUSS, CATHERINE TAYLOR MURPHY (PA-C)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:TAYLOR MURPHY
Last Name:RUSS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:TAYLOR
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2511 OLD CORNWALLIS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-1869
Mailing Address - Country:US
Mailing Address - Phone:919-932-5700
Mailing Address - Fax:
Practice Address - Street 1:2511 OLD CORNWALLIS RD STE 200
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-1869
Practice Address - Country:US
Practice Address - Phone:919-932-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-16
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3735363A00000X
NC0010-02712363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8102894Medicaid
NC2762665Medicare PIN
NC0397730007Medicare NSC