Provider Demographics
NPI:1295149920
Name:MUNMUN, MUNJERINA AHMD (MD)
Entity type:Individual
Prefix:DR
First Name:MUNJERINA
Middle Name:AHMD
Last Name:MUNMUN
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 1:41900 FENWICK ST STE 1
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-3815
Mailing Address - Country:US
Mailing Address - Phone:301-475-8860
Mailing Address - Fax:
Practice Address - Street 1:41900 FENWICK ST STE 1
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-3815
Practice Address - Country:US
Practice Address - Phone:301-475-8860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00838832084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty