Provider Demographics
NPI:1972894608
Name:OSCAR F MURILLO, MD, LLC
Entity Type:Organization
Organization Name:OSCAR F MURILLO, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-632-1234
Mailing Address - Street 1:250 FAME AVE
Mailing Address - Street 2:SUITE 205B
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-1587
Mailing Address - Country:US
Mailing Address - Phone:717-632-1234
Mailing Address - Fax:717-632-2934
Practice Address - Street 1:250 FAME AVE
Practice Address - Street 2:SUITE 205B
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-1587
Practice Address - Country:US
Practice Address - Phone:717-632-1234
Practice Address - Fax:717-632-2934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-28
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035407E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025823730001Medicaid