MEDICARE: JAMES JOSEPH MURDOCCO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	MD4044	RI
2	207YX0602X	Otolaryngic Allergy Physician	MD4044	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	050365986	OTHER		UNITED HEALTH
2	0000002255	OTHER		RI BLUE CROSS

General Provider Information

NPI Number	:	1093716656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES JOSEPH MURDOCCO MD

Provider Business Mailing Address
First Line	:	360 KINGSTOWN RD
Second Line	:
City	:	NARRAGANSETT
State	:	RI
Zip	:	02882-3239
Country	:	US
Telephone Number	:	401-789-0226
Fax Number	:	401-789-2335

Provider Business Practice Location Address
First Line	:	360 KINGSTOWN RD
Second Line	:
City	:	NARRAGANSETT
State	:	RI
Zip	:	02882-3239
Country	:	US
Telephone Number	:	401-789-0226
Fax Number	:	401-789-2335

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2005
Last Update Date	:	07/16/2012

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