1205404654 NPI number — MRS. ALEXANDRA ELIZABETH MURRAY AUD

Table of content: MRS. ALEXANDRA ELIZABETH MURRAY AUD (NPI 1205404654)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205404654 NPI number — MRS. ALEXANDRA ELIZABETH MURRAY AUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MURRAY
Provider First Name:
ALEXANDRA
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
AUD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZORBACH
Provider Other First Name:
ALEXANDRA
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
AUD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205404654
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
938 NATIONAL HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAVALE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-729-1635
Provider Business Mailing Address Fax Number:
301-729-1697

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
938 NATIONAL HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAVALE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-729-1635
Provider Business Practice Location Address Fax Number:
301-729-1697
Provider Enumeration Date:
06/14/2021

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: 231H00000X , with the licence number:  01553 , 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: 309170800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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