MEDICARE: DR. GLENN C. MURRAY 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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	0101236969	VA

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

General Provider Information

NPI Number	:	1326011750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLENN C. MURRAY MD

Provider Business Mailing Address
First Line	:	PO BOX 7068
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23707-0068
Country	:	US
Telephone Number	:	757-686-3516
Fax Number	:	757-686-0230

Provider Business Practice Location Address
First Line	:	1060 FIRST COLONIAL RD
Second Line	:	TIDEWATER INTEGRATED MEDICAL SERVICES PLLC
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-3002
Country	:	US
Telephone Number	:	757-967-8622
Fax Number	:	757-686-0541

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	07/20/2015

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