1104099027 NPI number — RADHEY S MURARKA MD PC

Table of content: (NPI 1104099027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104099027 NPI number — RADHEY S MURARKA MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RADHEY S MURARKA MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1104099027
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 427
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CABIN JOHN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20818-0427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-762-0785
Provider Business Mailing Address Fax Number:
301-762-0449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 W EDMONSTON DR
Provider Second Line Business Practice Location Address:
STE 604
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20852-1228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-762-0785
Provider Business Practice Location Address Fax Number:
301-762-0449
Provider Enumeration Date:
04/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MURARKA
Authorized Official First Name:
RADHEY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
301-762-0785

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  D29816 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DE8164 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 693ARA . This is a "CAREFIRST BCBS OF MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: J612 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 218661600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com