Provider Demographics
NPI:1366616302
Name:MASTER, MURRAY R (MD)
Entity type:Individual
Prefix:
First Name:MURRAY
Middle Name:R
Last Name:MASTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3180 MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-4237
Mailing Address - Country:US
Mailing Address - Phone:203-374-0404
Mailing Address - Fax:203-372-4167
Practice Address - Street 1:3180 MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-4237
Practice Address - Country:US
Practice Address - Phone:203-374-0404
Practice Address - Fax:203-372-4167
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT20077207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001200773Medicaid
CTB38164Medicare UPIN
CT001200773Medicaid