Provider Demographics
NPI:1316145121
Name:MURPHY, COLLEEN E (DO)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:E
Last Name:MURPHY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:MURPHY
Other - Last Name:LUKASEWICZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1000 WATERDAM PLAZA DR STE 240
Mailing Address - Street 2:
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-5427
Mailing Address - Country:US
Mailing Address - Phone:724-941-2018
Mailing Address - Fax:724-941-2093
Practice Address - Street 1:1000 WATERDAM PLAZA DR STE 240
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-5427
Practice Address - Country:US
Practice Address - Phone:724-941-2018
Practice Address - Fax:724-941-2093
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2020-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012930207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102302980Medicaid
PA149470Medicare PIN