=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184636763
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARY K MURRAY, MD, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4000 EMBASSY PKWY SUITE 320
-----------------------------------------------------
City | AKRON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44333-8315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-670-9700
-----------------------------------------------------
Fax | 330-670-9710
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 797 EAST AVE
-----------------------------------------------------
City | TALLMADGE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44278-2566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-633-0379
-----------------------------------------------------
Fax | 330-633-0379
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MARY K MURRAY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 330-670-9700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 35077016
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------