Healthcare Provider Details

I. General information

NPI: 1659989440
Provider Name (Legal Business Name): PATRICK MURPHY OGDEN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2020
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11050 MT BELVEDERE BLVD
FORT DRUM NY
13602-2603
US

IV. Provider business mailing address

80209B N LEWIS ST
WATERTOWN NY
13603-4096
US

V. Phone/Fax

Practice location:
  • Phone: 315-772-6976
  • Fax:
Mailing address:
  • Phone: 502-640-4465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: