Provider Demographics
NPI:1942261987
Name:MUNOZ, MYRIA (MD)
Entity Type:Individual
Prefix:
First Name:MYRIA
Middle Name:
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:978-466-3212
Mailing Address - Fax:978-534-3581
Practice Address - Street 1:165 MILL ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453
Practice Address - Country:US
Practice Address - Phone:978-466-3212
Practice Address - Fax:978-534-3581
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA58800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
042472266OtherPRIVATE HEALTHCARE SYSTEM
MA3031730Medicaid
042472266OtherHEALTHCARE VALUE MGMT
26843OtherHEALTHY START
5601458OtherAETNA US HEALTHCARE
9900817OtherFALLON COMMUNITY HLTH PLN
J07172OtherBLUE SHIELD HMO BLUE
1107579OtherCIGNA HEALTH PLAN
784165OtherMVP HEALTH CARE
042472266OtherONE HEALTH PLAN
3031730OtherMEDICAID/WELFARE
AA1273OtherHARVARD PILGRIM HEALTHCAR
J07172OtherBLUE CARE ELECT
1150185OtherFIRST HEALTH
J07172OtherBLUE SHIELD INDEMNITY
J07172OtherMEDICARE B
0401687OtherEVERCARE
26843OtherCHILDRENS MED SEC PLAN
MA3031730Medicaid
J07172OtherMEDICARE B