Basic Information
| Provider Information | |||||||||
| NPI: | 1639274301 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURRAY | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | PATRICK | ||||||||
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| Credential: | D.P.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1432 BIRCHCREST LN | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229118285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349738226 | ||||||||
| FaxNumber: | 4349798880 | ||||||||
| Practice Location | |||||||||
| Address1: | 887A RIO EAST CT | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229018004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349798116 | ||||||||
| FaxNumber: | 4349798880 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2006 | ||||||||
| LastUpdateDate: | 11/28/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ER0200X | 0103000815 | VA | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Radiology | 213ES0000X | 0103000815 | VA | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Sports Medicine | 213ES0103X | 0103000815 | VA | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | 213ES0131X | 0103000815 | VA | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery | 213E00000X | 0103000815 | VA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | 213EP1101X | 0103000815 | VA | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Primary Podiatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 249374 | 01 | VA | SOUTHERN HEALTH | OTHER | P00182304 | 01 | VA | MEDICARE RAILROAD | OTHER | 467185 | 01 | VA | OPTIMUM CHOICE | OTHER | 12634 | 01 | VA | COMMUNITY HEALTH/SENTARA | OTHER | 5385000002 | 01 | VA | MEDICARE DME W'BORO OFFIC | OTHER | 170948 | 01 | VA | ANTHEM W'BORO OFFICE | OTHER | 201847246 | 01 | VA | TRICARE | OTHER | 467185 | 01 | VA | ALLIANCE PPO | OTHER | 010135770 | 05 | VA | MEDICAID | 010136016 | 05 | VA | MEDICAID | 170640 | 01 | VA | ANTHEM, C'VILLE OFFICE | OTHER | 0103000815 | 01 | VA | STATE LICENSE | OTHER | 5385000001 | 01 | VA | MEDICARE DME, CHAR OFFICE | OTHER | 3627140001 | 01 | VA | CIGNA | OTHER | 467185 | 01 | VA | MAMSI | OTHER | P68466325 | 01 | VA | MULTI-PLAN | OTHER |