Provider Demographics
NPI:1639274301
Name:MURRAY, KEVIN PATRICK (DPM)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:PATRICK
Last Name:MURRAY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 BIRCHCREST LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-8285
Mailing Address - Country:US
Mailing Address - Phone:434-973-8226
Mailing Address - Fax:434-979-8880
Practice Address - Street 1:887A RIO EAST CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-8004
Practice Address - Country:US
Practice Address - Phone:434-979-8116
Practice Address - Fax:434-979-8880
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000815213ER0200X, 213ES0000X, 213ES0103X, 213ES0131X, 213E00000X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA249374OtherSOUTHERN HEALTH
VAP00182304OtherMEDICARE RAILROAD
VA467185OtherOPTIMUM CHOICE
VA12634OtherCOMMUNITY HEALTH/SENTARA
VA5385000002OtherMEDICARE DME W'BORO OFFIC
VA170948OtherANTHEM W'BORO OFFICE
VA201847246OtherTRICARE
VA467185OtherALLIANCE PPO
VA010135770Medicaid
VA010136016Medicaid
VA170640OtherANTHEM, C'VILLE OFFICE
VA0103000815OtherSTATE LICENSE
VA5385000001OtherMEDICARE DME, CHAR OFFICE
VA3627140001OtherCIGNA
VA467185OtherMAMSI
VAP68466325OtherMULTI-PLAN
VAT01425Medicare UPIN
VA006418B09Medicare ID - Type Unspecified