Provider Demographics
NPI:1477615474
Name:MDFAMILY MEDICAL GROUP, PA
Entity Type:Organization
Organization Name:MDFAMILY MEDICAL GROUP, PA
Other - Org Name:MDFAMILY MEDICAL GROUP, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CREDENTIALING/FINANCE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-688-0324
Mailing Address - Street 1:230 E W T HARRIS BLVD
Mailing Address - Street 2:SUITE C-13
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3492
Mailing Address - Country:US
Mailing Address - Phone:704-688-0324
Mailing Address - Fax:704-549-8043
Practice Address - Street 1:230 E W T HARRIS BLVD
Practice Address - Street 2:SUITE C-13
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3492
Practice Address - Country:US
Practice Address - Phone:704-688-0324
Practice Address - Fax:704-549-8043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty