Provider Demographics
NPI:1821806696
Name:MURRAY, MACK NICHOLAS
Entity type:Individual
Prefix:
First Name:MACK
Middle Name:NICHOLAS
Last Name:MURRAY
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 1:10 GRASSY PLAIN RD.
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 GRASSY PLAIN RD.
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806
Practice Address - Country:US
Practice Address - Phone:386-249-4515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-24
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered