Provider Demographics
NPI:1306849666
Name:MURRAY, LAURA ANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANNE
Last Name:MURRAY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 PARKSIDE AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-4714
Mailing Address - Country:US
Mailing Address - Phone:215-879-6116
Mailing Address - Fax:215-477-0973
Practice Address - Street 1:5000 PARKSIDE AVENUE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-4714
Practice Address - Country:US
Practice Address - Phone:215-879-6116
Practice Address - Fax:215-477-0973
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012281207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102074605-0001Medicaid