=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700291374
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | S DEBORAH MURPHY MD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2014
-----------------------------------------------------
Last Update Date | 06/23/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 450 VETERANS MEMORIAL PKWY SUITE 504
-----------------------------------------------------
City | EAST PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02914-5300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-431-1119
-----------------------------------------------------
Fax | 401-431-1125
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 450 VETERANS MEMORIAL PKWY SUITE 504
-----------------------------------------------------
City | EAST PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02914-5300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-431-1119
-----------------------------------------------------
Fax | 401-431-1125
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MEMBER
-----------------------------------------------------
Name | S DEBORAH MURPHY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 401-431-1119
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | MD05551
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------