Provider Demographics
NPI:1396214763
Name:MURDY, MICHAELA JULIANN
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:JULIANN
Last Name:MURDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-8801
Mailing Address - Country:US
Mailing Address - Phone:740-968-7006
Mailing Address - Fax:740-986-7256
Practice Address - Street 1:4697 HARRISON ST
Practice Address - Street 2:2 SOUTH BELMONT COMMUNITY HOSPITAL
Practice Address - City:BELLAIRE
Practice Address - State:OH
Practice Address - Zip Code:43793
Practice Address - Country:US
Practice Address - Phone:740-671-1270
Practice Address - Fax:740-671-1272
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1629560172Medicaid