Provider Demographics
NPI:1821705971
Name:MURPHY, ISABELLA A
Entity Type:Individual
Prefix:
First Name:ISABELLA
Middle Name:A
Last Name:MURPHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14913 MCINTOSH CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-4313
Mailing Address - Country:US
Mailing Address - Phone:301-395-8266
Mailing Address - Fax:
Practice Address - Street 1:11900 BOURNEFIELD WAY
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7822
Practice Address - Country:US
Practice Address - Phone:301-658-1986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDGOM830172423OtherCAREFIRST BLUECHOICE MEMBER ID