Provider Demographics
NPI:1346236114
Name:MUNKAILA, IBRAHIM A (MD)
Entity Type:Individual
Prefix:DR
First Name:IBRAHIM
Middle Name:A
Last Name:MUNKAILA
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1101 SAM PERRY BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4467
Mailing Address - Country:US
Mailing Address - Phone:540-741-3340
Mailing Address - Fax:540-741-3348
Practice Address - Street 1:1001 SAM PERRY BLVD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4453
Practice Address - Country:US
Practice Address - Phone:540-741-3340
Practice Address - Fax:540-741-3348
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235182208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H97665Medicare UPIN