MEDICARE: MRS. ALISA MARIE MURPHY PA-C

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	363A00000X	Physician Assistant	011920	NY

General Provider Information

NPI Number	:	1134276652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALISA MARIE MURPHY PA-C

Provider Business Mailing Address
First Line	:	2949 ERIE BLVD E
Second Line	:	SUITE 110
City	:	SYRACUSE
State	:	NY
Zip	:	13224-1442
Country	:	US
Telephone Number	:	315-424-1430
Fax Number	:	315-424-1779

Provider Business Practice Location Address
First Line	:	2949 ERIE BLVD E
Second Line	:	SUITE 110
City	:	SYRACUSE
State	:	NY
Zip	:	13224-1442
Country	:	US
Telephone Number	:	315-424-1430
Fax Number	:

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

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	10/25/2016

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