Provider Demographics
NPI:1063497584
Name:MUNZER, FREDRICK WILLIAM (DO)
Entity Type:Individual
Prefix:
First Name:FREDRICK
Middle Name:WILLIAM
Last Name:MUNZER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 FULMER RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-4602
Mailing Address - Country:US
Mailing Address - Phone:814-269-4507
Mailing Address - Fax:814-535-4819
Practice Address - Street 1:411 THEATRE DR
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-2838
Practice Address - Country:US
Practice Address - Phone:814-269-4507
Practice Address - Fax:814-288-0194
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05005422L207Q00000X
PAOS005422L207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
099570Medicare ID - Type Unspecified
B36355Medicare UPIN