Provider Demographics
NPI:1184652620
Name:MURPHY, CHARLES THOMAS (DPM)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:THOMAS
Last Name:MURPHY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 NEW RD
Mailing Address - Street 2:BLDG. 2; STE. 5
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1299
Mailing Address - Country:US
Mailing Address - Phone:609-653-2066
Mailing Address - Fax:609-653-8480
Practice Address - Street 1:222 NEW RD
Practice Address - Street 2:BLDG. 2; STE. 5
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1299
Practice Address - Country:US
Practice Address - Phone:609-653-2066
Practice Address - Fax:609-653-8480
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00163800213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1144405Medicaid
NJ0000133884Medicare ID - Type Unspecified
NJ1144405Medicaid