Provider Demographics
NPI:1104844299
Name:MURDOCK, ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:MURDOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4923 COLONIAL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3906
Mailing Address - Country:US
Mailing Address - Phone:540-769-2026
Mailing Address - Fax:540-769-2028
Practice Address - Street 1:4923 COLONIAL AVE STE B
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3906
Practice Address - Country:US
Practice Address - Phone:540-769-2026
Practice Address - Fax:540-769-2028
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010462332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7119003Medicaid
VAF25546Medicare UPIN
VA00V258R41Medicare ID - Type Unspecified