Provider Demographics
NPI:1912936089
Name:SHANTHA K. MURTHY,M.D.,P.C.
Entity type:Organization
Organization Name:SHANTHA K. MURTHY,M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:SHANTHA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MURTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-839-4062
Mailing Address - Street 1:6196 OXON HILL RD
Mailing Address - Street 2:SUITE 520
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3100
Mailing Address - Country:US
Mailing Address - Phone:301-839-4062
Mailing Address - Fax:301-839-7016
Practice Address - Street 1:6196 OXON HILL RD
Practice Address - Street 2:SUITE 520
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3100
Practice Address - Country:US
Practice Address - Phone:301-839-4062
Practice Address - Fax:301-839-7016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD12585207RI0200X
MDD0024064207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD442613Medicare PIN