Provider Demographics
NPI:1295762508
Name:MURR, PHYLLIS A (MD)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:A
Last Name:MURR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 GREEN HILLS RD
Mailing Address - Street 2:
Mailing Address - City:BIRDSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19508-8374
Mailing Address - Country:US
Mailing Address - Phone:610-670-4114
Mailing Address - Fax:610-670-4101
Practice Address - Street 1:ROUTE 422, SPORTSMAN ROAD
Practice Address - Street 2:BUILDING 37
Practice Address - City:WERNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19565-0300
Practice Address - Country:US
Practice Address - Phone:610-670-4114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018215E207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE77148Medicare UPIN
113844Medicare PIN