Provider Demographics
NPI:1194762872
Name:MURTHA, ELLA (PAC)
Entity type:Individual
Prefix:
First Name:ELLA
Middle Name:
Last Name:MURTHA
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 RITCHIE HIGHWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012
Mailing Address - Country:US
Mailing Address - Phone:410-544-4855
Mailing Address - Fax:410-315-9150
Practice Address - Street 1:1600 S CRAIN HIGHWAY
Practice Address - Street 2:SUITE 401
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061
Practice Address - Country:US
Practice Address - Phone:410-768-5050
Practice Address - Fax:410-768-7830
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC0002498363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S75392Medicare UPIN