Provider Demographics
NPI:1306967864
Name:MURTAGH, SUSAN P (NP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:P
Last Name:MURTAGH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:I
Other - Last Name:PETRACCA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:340 THOMPSON RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:WEBSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01570-1509
Mailing Address - Country:US
Mailing Address - Phone:508-943-5132
Mailing Address - Fax:508-943-5209
Practice Address - Street 1:340 THOMPSON RD
Practice Address - Street 2:SUITE 108
Practice Address - City:WEBSTER
Practice Address - State:MA
Practice Address - Zip Code:01570-1509
Practice Address - Country:US
Practice Address - Phone:508-943-5132
Practice Address - Fax:508-943-5209
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA188207363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS59832Medicare UPIN
MANP125203Medicare PIN
MANP1252Medicare ID - Type Unspecified