Provider Demographics
NPI:1700291374
Name:S DEBORAH MURPHY MD LLC
Entity type:Organization
Organization Name:S DEBORAH MURPHY MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:S
Authorized Official - Middle Name:DEBORAH
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-431-1119
Mailing Address - Street 1:450 VETERANS MEMORIAL PKWY
Mailing Address - Street 2:SUITE 504
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-5300
Mailing Address - Country:US
Mailing Address - Phone:401-431-1119
Mailing Address - Fax:401-431-1125
Practice Address - Street 1:450 VETERANS MEMORIAL PKWY
Practice Address - Street 2:SUITE 504
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-5300
Practice Address - Country:US
Practice Address - Phone:401-431-1119
Practice Address - Fax:401-431-1125
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:S DEBORAH MURPHY MD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD05551207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI189000967OtherMEDICARE PTAN
RIB76305Medicare UPIN