Provider Demographics
NPI:1700897782
Name:MUNK, MARC-DAVID (MD)
Entity Type:Individual
Prefix:
First Name:MARC-DAVID
Middle Name:
Last Name:MUNK
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 1:30 NEWBURY ST STE 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-3239
Mailing Address - Country:US
Mailing Address - Phone:617-729-4800
Mailing Address - Fax:
Practice Address - Street 1:30 NEWBURY ST STE 3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3239
Practice Address - Country:US
Practice Address - Phone:617-729-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA256720207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I63006Medicare UPIN
PA1016828660001Medicaid
PA104210GXFMedicare PIN
PAP00350062Medicare PIN
WV3810008988Medicaid