1780740894 NPI number — MR. ROBIN CHASE MURTHA MSN, APRN

Table of content: MR. ROBIN CHASE MURTHA MSN, APRN (NPI 1780740894)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780740894 NPI number — MR. ROBIN CHASE MURTHA MSN, APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MURTHA
Provider First Name:
ROBIN
Provider Middle Name:
CHASE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSN, APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780740894
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
32 FARMVIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GUILFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06437-2514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-458-8607
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2505 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 223
Provider Business Practice Location Address City Name:
STRATFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06615-5839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-375-5812
Provider Business Practice Location Address Fax Number:
203-375-6027
Provider Enumeration Date:
01/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  002748 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004247286-00 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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