1497701486 NPI number — TERESA MUNS DO

Table of content: TERESA MUNS DO (NPI 1497701486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497701486 NPI number — TERESA MUNS DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUNS
Provider First Name:
TERESA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497701486
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
307 S EVERGREEN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODBURY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08096-2739
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-686-4300
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9000 FRANKLIN SQUARE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21237-3901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-777-7046
Provider Business Practice Location Address Fax Number:
443-777-7587
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  H0059540 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 223665638001 . This is a "CHAMPUS/TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 400831600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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