MEDICARE: CHRISTOPHER B MURRY D.O

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	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	1526	ME
2	207YS0012X	Sleep Medicine (Otolaryngology) Physician	1526	ME

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	HX1691	OTHER	ME	MEDICARE PTAN GRP MM8648
3	AX6996	OTHER	ME	MEDICARE PTAN GRP 152556

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	018247	OTHER	ME	ANTHEM
5	1044199	OTHER	ME	AETNA
6	G02574	OTHER	ME	HARVARD PILGRIM

General Provider Information

NPI Number	:	1174511158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER B MURRY D.O

Provider Business Mailing Address
First Line	:	301C US ROUTE 1
Second Line	:
City	:	SCARBOROUGH
State	:	ME
Zip	:	04074-9701
Country	:	US
Telephone Number	:	207-396-8600
Fax Number	:	207-396-8632

Provider Business Practice Location Address
First Line	:	1250 FOREST AVE
Second Line	:	SUITE 301
City	:	PORTLAND
State	:	ME
Zip	:	04103-1884
Country	:	US
Telephone Number	:	207-797-5753
Fax Number	:	207-878-1715

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	04/13/2012

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Directions to “ CHRISTOPHER B MURRY D.O” Practice Location

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