Provider Demographics
NPI:1689748733
Name:MURANO, JOSEPH ROBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ROBERT
Last Name:MURANO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:JOSEPH
Other - Middle Name:ROBERT
Other - Last Name:MURAO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:101 MAIN ST
Mailing Address - Street 2:STE 207
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4530
Mailing Address - Country:US
Mailing Address - Phone:781-396-0120
Mailing Address - Fax:781-395-4535
Practice Address - Street 1:101 MAIN ST
Practice Address - Street 2:207
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4530
Practice Address - Country:US
Practice Address - Phone:781-396-0120
Practice Address - Fax:781-395-4535
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1861213E00000X
MA1861213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
709632OtherTU HZ
MA0362018Medicaid
Y70876Medicare ID - Type Unspecified
MA0362018Medicaid