Provider Demographics
NPI:1508831728
Name:MUNOZ, MARC E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:E
Last Name:MUNOZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 16180
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-6180
Mailing Address - Country:US
Mailing Address - Phone:757-312-6585
Mailing Address - Fax:757-312-6744
Practice Address - Street 1:736 N BATTLEFIELD BLVD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4941
Practice Address - Country:US
Practice Address - Phone:757-312-6585
Practice Address - Fax:757-312-6744
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236017207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010053951Medicaid
VAVAA103718Medicare PIN
VA012038C05Medicare PIN
VA010053951Medicaid