Provider Demographics
NPI:1740219922
Name:MAUNG, PETER K (MD, FACP, CMD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:K
Last Name:MAUNG
Suffix:
Gender:M
Credentials:MD, FACP, CMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 61147
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29419-1147
Mailing Address - Country:US
Mailing Address - Phone:843-343-3188
Mailing Address - Fax:843-824-9342
Practice Address - Street 1:9319 MEDICAL PLAZA DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9103
Practice Address - Country:US
Practice Address - Phone:843-343-3188
Practice Address - Fax:843-824-9342
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22387207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT65925Medicaid
SCT65925Medicaid
SCH309660281Medicare PIN