Provider Demographics
NPI:1831288125
Name:MURRAY, SUSAN A (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:MURRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 NEW HAMPSHIRE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-2838
Mailing Address - Country:US
Mailing Address - Phone:603-431-2516
Mailing Address - Fax:603-431-9945
Practice Address - Street 1:25 NEW HAMPSHIRE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-2838
Practice Address - Country:US
Practice Address - Phone:603-431-2516
Practice Address - Fax:603-431-9945
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10563207Q00000X
ME014993207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3082917Medicaid
G97406Medicare UPIN
NH3082917Medicaid