Basic Information
| Provider Information | |||||||||
| NPI: | 1689613176 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURDOCK | ||||||||
| FirstName: | MYRON | ||||||||
| MiddleName: | IRWIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 7500 GREENWAY CENTER DR | ||||||||
| Address2: | 8TH FLOOR | ||||||||
| City: | GREENBELT | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207703502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014772000 | ||||||||
| FaxNumber: | 3014742389 | ||||||||
| Practice Location | |||||||||
| Address1: | 7500 GREENWAY CENTER DR | ||||||||
| Address2: | 8TH FLOOR | ||||||||
| City: | GREENBELT | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207703502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014772000 | ||||||||
| FaxNumber: | 3014742389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 01/25/2013 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | D0018073 | MD | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 35302006 | 01 | BCBS MD | OTHER | 310901101 | 05 | MD | MEDICAID | 4054319 | 01 | AETNA PPO | OTHER | G02425M04 | 01 | MEDICARE MD | OTHER | 028052 | 01 | JOHN HOPKINS | OTHER | 35302005 | 01 | BCBS MD | OTHER | 0926863 | 01 | CIGNA | OTHER | 1467394 | 01 | AETNA HMO | OTHER | 432105237 | 01 | BRAVO HEALTH | OTHER | 33113 | 01 | OPT CHOICE | OTHER | 57620010 | 01 | BCBS DC | OTHER | P00439846 | 01 | RAILROAD MEDICARE | OTHER | 028052 | 01 | PRIORITY PARTNERS | OTHER | 1901960 | 01 | UHC AMERICHOICE | OTHER | 35302007 | 01 | BCBS MD | OTHER |