Provider Demographics
NPI:1811209828
Name:MACK, AMBER MURPHY (MD)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:MURPHY
Last Name:MACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMBER
Other - Middle Name:KAY
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1109 CANIFF RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-1619
Mailing Address - Country:US
Mailing Address - Phone:614-738-0026
Mailing Address - Fax:
Practice Address - Street 1:7450 HOSPITAL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-9642
Practice Address - Country:US
Practice Address - Phone:614-659-9519
Practice Address - Fax:614-659-0580
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35122752207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH322930OtherMEDICARE PTAN