Basic Information
| Provider Information | |||||||||
| NPI: | 1205377959 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURPHY | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | |||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 ROCK LITITZ BLVD STE 14 | ||||||||
| Address2: | |||||||||
| City: | LITITZ | ||||||||
| State: | PA | ||||||||
| PostalCode: | 175431369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175447625 | ||||||||
| FaxNumber: | 7176272633 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 ROCK LITITZ BLVD STE 14 | ||||||||
| Address2: | |||||||||
| City: | LITITZ | ||||||||
| State: | PA | ||||||||
| PostalCode: | 175431369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175447625 | ||||||||
| FaxNumber: | 7176272633 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2017 | ||||||||
| LastUpdateDate: | 01/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MA060515 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 6660 | AZ | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.