=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376854752
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MURTHY R CHAMARTHY M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2010
-----------------------------------------------------
Last Update Date | 12/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1919 S SHILOH RD STE 400
-----------------------------------------------------
City | GARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75042-8211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-320-1267
-----------------------------------------------------
Fax | 945-242-8020
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O BOX 29650, DEPT# 880579
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85038-1117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-626-1746
-----------------------------------------------------
Fax | 480-626-2690
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | Q4916
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2085R0204X
-----------------------------------------------------
Taxonomy Name | Vascular & Interventional Radiology Physician
-----------------------------------------------------
License Number | Q4916
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------