Provider Demographics
NPI:1063474898
Name:MUNN, DANIEL DUDLEY (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:DUDLEY
Last Name:MUNN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:109 PHILIP ROTH ST
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-1393
Practice Address - Country:US
Practice Address - Phone:757-873-6434
Practice Address - Fax:757-873-1882
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101231737208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV0682AMedicare PIN
VA1063474898Medicaid
VAP00918167Medicare PIN