Provider Demographics
NPI:1003078213
Name:MURONDA, MONIQUE R (DPM)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:R
Last Name:MURONDA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10845 PHILADELPHIA RD
Mailing Address - Street 2:
Mailing Address - City:WHITE MARSH
Mailing Address - State:MD
Mailing Address - Zip Code:21162-1717
Mailing Address - Country:US
Mailing Address - Phone:410-335-0008
Mailing Address - Fax:410-335-3113
Practice Address - Street 1:44135 WOODRIDGE PKWY
Practice Address - Street 2:SUITE 180
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-1244
Practice Address - Country:US
Practice Address - Phone:571-223-0424
Practice Address - Fax:571-223-0425
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-29
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPO1000107213ES0103X
VA0103301051213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC081745500OtherMEDICAL ASSISTANCE
VA1003078214OtherMEDICAL ASSISTANCE