1376854752 NPI number — DR. MURTHY R CHAMARTHY M.D.

Table of content: DR. MURTHY R CHAMARTHY M.D. (NPI 1376854752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376854752 NPI number — DR. MURTHY R CHAMARTHY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAMARTHY
Provider First Name:
MURTHY
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1376854752
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O BOX 29650, DEPT# 880579
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85038-1117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-626-1746
Provider Business Mailing Address Fax Number:
480-626-2690

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1919 S SHILOH RD STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75042-8211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-320-1267
Provider Business Practice Location Address Fax Number:
945-242-8020
Provider Enumeration Date:
06/30/2010

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: 2085R0202X , with the licence number:  Q4916 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: Q4916 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 111753000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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