Provider Demographics
NPI:1083652622
Name:MAUNG, KHIN RUPPA WADDY (MD)
Entity type:Individual
Prefix:DR
First Name:KHIN RUPPA
Middle Name:WADDY
Last Name:MAUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 62026
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-2026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1120 N ROLLING RD
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-3826
Practice Address - Country:US
Practice Address - Phone:410-744-8822
Practice Address - Fax:410-744-5117
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0056468207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS190/ 0046OtherBLUE CHOICE
MDKF68/ 609776-02OtherBC/BS OF MD
MDH36357Medicare UPIN
MDKL28/ A138Medicare ID - Type Unspecified