Provider Demographics
NPI:1669715116
Name:MURNEY, SEAN RYAN
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:RYAN
Last Name:MURNEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 TEMIE LEE PKWY
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2061
Mailing Address - Country:US
Mailing Address - Phone:315-729-1828
Mailing Address - Fax:
Practice Address - Street 1:261 MEDICAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9337
Practice Address - Country:US
Practice Address - Phone:804-835-9748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34011732207R00000X
VA0116030264207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0125887Medicaid
OHH411120Medicare PIN
OH0125887Medicaid