Provider Demographics
NPI:1609169739
Name:MU, DI
Entity Type:Individual
Prefix:
First Name:DI
Middle Name:
Last Name:MU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:MU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:28 ALLEGHENY AVE STE 1202
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-3919
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28 ALLEGHENY AVE STE 1202
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-3919
Practice Address - Country:US
Practice Address - Phone:443-470-9065
Practice Address - Fax:410-825-2979
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00804592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry