1619953544 NPI number — DR. DONNA M MURRAY PHD

Table of content: DR. DONNA M MURRAY PHD (NPI 1619953544)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619953544 NPI number — DR. DONNA M MURRAY PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MURRAY
Provider First Name:
DONNA
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1619953544
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:
67828 BROKAW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST CLAIRSVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43950
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-695-6101
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
67828 BROKAW RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST CLAIRSVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-695-6101
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/22/2005

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: 103T00000X , with the licence number:  3619 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103T00000X , with the licence number: 428 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0616140 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1425029 . This is a "THE UMWA H & R FUNDS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 690476 . This is a "PENNSYLVANIA BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 113384 . This is a "MENTAL HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6021977373 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0163115000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: Y926780 . This is a "HEALTH PLAN OF UPPER OHIO" identifier . This identifiers is of the category "OTHER".




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