Provider Demographics
NPI:1295722866
Name:MAUNG, M. OHN (MD)
Entity type:Individual
Prefix:
First Name:M.
Middle Name:OHN
Last Name:MAUNG
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:PO BOX 42119
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22404-2119
Mailing Address - Country:US
Mailing Address - Phone:703-731-1915
Mailing Address - Fax:
Practice Address - Street 1:3920 PLANK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-7104
Practice Address - Country:US
Practice Address - Phone:540-786-1990
Practice Address - Fax:540-786-1997
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233399207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA017428V57Medicare PIN
00V350M89Medicare PIN
G40414Medicare UPIN