Provider Demographics
NPI:1639164791
Name:MURCHISON, AMANDA (MD)
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:
Last Name:MURCHISON
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 1:102 HIGHLAND AVE SE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24013-2256
Mailing Address - Country:US
Mailing Address - Phone:540-981-2987
Mailing Address - Fax:540-344-5280
Practice Address - Street 1:102 HIGHLAND AVE SE
Practice Address - Street 2:SUITE 303
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24013-2256
Practice Address - Country:US
Practice Address - Phone:540-981-2987
Practice Address - Fax:540-344-5280
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2021-08-17
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-07
Provider Licenses
StateLicense IDTaxonomies
VA0101242175207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12158330Medicaid
CO535938Medicare ID - Type Unspecified
VA014640C19Medicare PIN
CO12158330Medicaid