Healthcare Provider Details

I. General information

NPI: 1275530545
Provider Name (Legal Business Name): MURRAY WILSON WEST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 ERDMAN AVE
BALTIMORE MD
21213-1720
US

IV. Provider business mailing address

3501 SINCLAIR LN
BALTIMORE MD
21213-2029
US

V. Phone/Fax

Practice location:
  • Phone: 410-558-4800
  • Fax: 410-675-8947
Mailing address:
  • Phone: 410-558-4888
  • Fax: 410-327-1693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD34146
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: