Provider Demographics
NPI:1821099284
Name:MUNDY, MARTHA R (AUD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:R
Last Name:MUNDY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4915 MONTVALE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-4932
Mailing Address - Country:US
Mailing Address - Phone:919-493-5436
Mailing Address - Fax:
Practice Address - Street 1:CAMPUS BOX 7190 WING D MEDICAL SCHOOL
Practice Address - Street 2:UNIVERSITY OF NORTH CAROLINA
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-0001
Practice Address - Country:US
Practice Address - Phone:919-966-9457
Practice Address - Fax:919-966-0100
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC904OtherNCHADLB