Provider Demographics
NPI:1700983467
Name:MUNN, CHARLES SAMSON (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:SAMSON
Last Name:MUNN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHARLES
Other - Middle Name:SAMSON
Other - Last Name:MUNN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, FACR
Mailing Address - Street 1:20642 JOHN DR
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5103
Mailing Address - Country:US
Mailing Address - Phone:510-581-2559
Mailing Address - Fax:
Practice Address - Street 1:20642 JOHN DR
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5103
Practice Address - Country:US
Practice Address - Phone:510-581-2559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG471972085R0202X, 2085R0202X, 208D00000X
NH22222208D00000X, 2085N0904X
MA44407208D00000X, 2085R0202X, 2085N0904X, 2085R0202X, 208D00000X
NY162304-12085R0202X, 208D00000X
NM2003-02752085R0202X
AZ325872085R0202X
GA0546542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB74194MAMedicare UPIN