Provider Demographics
NPI:1477949295
Name:LATE, BRUNILDA MUNIR (MD)
Entity Type:Individual
Prefix:
First Name:BRUNILDA
Middle Name:MUNIR
Last Name:LATE
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 1:13400 EDGEMEADE RD
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-8088
Mailing Address - Country:US
Mailing Address - Phone:717-763-2901
Mailing Address - Fax:717-763-2803
Practice Address - Street 1:13400 EDGEMEADE RD
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-8088
Practice Address - Country:US
Practice Address - Phone:301-358-0192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101271547207P00000X
PAMD464746207P00000X
MDD00909802083A0300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program