Provider Demographics
NPI:1518957976
Name:MUNNELLY, KEVIN PETER (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:PETER
Last Name:MUNNELLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1510
Mailing Address - Street 2:CHEVY CHASE ANESTHESIA LLC
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20875-1510
Mailing Address - Country:US
Mailing Address - Phone:301-528-0222
Mailing Address - Fax:301-515-4153
Practice Address - Street 1:20201 CENTURY BLVD
Practice Address - Street 2:STE 480 CHEVY CHASE ANESTHESIA LLC
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1113
Practice Address - Country:US
Practice Address - Phone:301-528-0222
Practice Address - Fax:301-515-4153
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0060410207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Not Answered207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC5417OtherBC BS GRP
DC0005OtherBC BS
MD613896 03OtherCAREFIRST BC BS
MDP00110010OtherRR MEDICARE
727MC552Medicare ID - Type Unspecified
G04214Medicare UPIN