Healthcare Provider Details

I. General information

NPI: 1831488576
Provider Name (Legal Business Name): COLLEEN MARGARET MURTAGH CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 JORDAN RD SUITE 200
TROY NY
12180-8343
US

IV. Provider business mailing address

PO BOX 14890
ALBANY NY
12212-4890
US

V. Phone/Fax

Practice location:
  • Phone: 518-274-0476
  • Fax: 518-274-0497
Mailing address:
  • Phone: 518-525-5634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberF001430
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: