Provider Demographics
NPI: | 1497715692 |
---|---|
Name: | MURPHY, MARK TIMOTHY (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | MARK |
Middle Name: | TIMOTHY |
Last Name: | MURPHY |
Suffix: | |
Gender: | M |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | PO BOX 936857 |
Mailing Address - Street 2: | |
Mailing Address - City: | ATLANTA |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 31193-6857 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 910-662-9500 |
Mailing Address - Fax: | 910-662-9501 |
Practice Address - Street 1: | 1415 PHYSICIANS DR |
Practice Address - Street 2: | |
Practice Address - City: | WILMINGTON |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28401-7338 |
Practice Address - Country: | US |
Practice Address - Phone: | 910-662-9500 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-03-23 |
Last Update Date: | 2023-09-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 200000281 | 207RC0000X |
NC | 2000-00281 | 207RC0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NC | 89013PE | Medicaid | |
NC | 89126G1 | Medicaid | |
NC | 1497715692 | Medicaid | |
NC | 89013PE | Medicaid | |
NC | NCN085A | Medicare PIN | |
NC | 2280291E | Medicare PIN | |
NC | 89126G1 | Medicaid |