Provider Demographics
NPI:1598837742
Name:WANICUR, DAVID MURRAY (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MURRAY
Last Name:WANICUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11400 ROCKVILLE PIKE
Mailing Address - Street 2:STE. 301
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3004
Mailing Address - Country:US
Mailing Address - Phone:301-881-5888
Mailing Address - Fax:301-881-2945
Practice Address - Street 1:11400 ROCKVILLE PIKE
Practice Address - Street 2:STE. 301
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3004
Practice Address - Country:US
Practice Address - Phone:301-881-5888
Practice Address - Fax:301-881-2945
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD13127207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD164932M35Medicare PIN
MDB93874Medicare UPIN