Provider Demographics
NPI:1528043213
Name:MURNIN, MARK (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MURNIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 KELLY ST
Mailing Address - Street 2:STE 4
Mailing Address - City:ARCHBALD
Mailing Address - State:PA
Mailing Address - Zip Code:18403-1627
Mailing Address - Country:US
Mailing Address - Phone:570-876-1735
Mailing Address - Fax:570-876-1813
Practice Address - Street 1:358 HAMLIN HIGHWAY
Practice Address - Street 2:
Practice Address - City:HAMLIN
Practice Address - State:PA
Practice Address - Zip Code:18427
Practice Address - Country:US
Practice Address - Phone:570-689-2242
Practice Address - Fax:570-689-3416
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007532L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001277280Medicaid
PAF17454Medicare UPIN
PA711022NW4Medicare ID - Type Unspecified
PA110197531Medicare PIN