Provider Demographics
NPI:1215964929
Name:MUNOZ, MARIA LORDES (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LORDES
Last Name:MUNOZ
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 1:513 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16354-1453
Mailing Address - Country:US
Mailing Address - Phone:814-827-3794
Mailing Address - Fax:
Practice Address - Street 1:339 W SPRING ST
Practice Address - Street 2:SUITE 103
Practice Address - City:TITUSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16354-1655
Practice Address - Country:US
Practice Address - Phone:814-827-7004
Practice Address - Fax:814-827-4750
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD051288L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015299780004Medicaid
PAG07758Medicare UPIN