Provider Demographics
NPI:1639144470
Name:MURRAY, PATRICK MICHAEL (MD)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:MICHAEL
Last Name:MURRAY
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 489
Mailing Address - Street 2:RT 307
Mailing Address - City:LAKE WINOLA
Mailing Address - State:PA
Mailing Address - Zip Code:18625
Mailing Address - Country:US
Mailing Address - Phone:570-378-3047
Mailing Address - Fax:570-378-3418
Practice Address - Street 1:1240 SR 307
Practice Address - Street 2:
Practice Address - City:LAKE WINOLA
Practice Address - State:PA
Practice Address - Zip Code:18625
Practice Address - Country:US
Practice Address - Phone:570-378-3047
Practice Address - Fax:570-378-3418
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036522E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011240760002Medicaid
C34728Medicare UPIN
PA506961Medicare ID - Type Unspecified