Provider Demographics
NPI:1700983467
Name:MUNN, C S (MD, FACR)
Entity Type:Individual
Prefix:DR
First Name:C S
Middle Name:
Last Name:MUNN
Suffix:
Gender:M
Credentials:MD, FACR
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:PO BOX 3677
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03061-3677
Mailing Address - Country:US
Mailing Address - Phone:603-577-7900
Mailing Address - Fax:035-779-7972
Practice Address - Street 1:8 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3925
Practice Address - Country:US
Practice Address - Phone:603-577-3377
Practice Address - Fax:603-577-3387
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH222222085R0202X, 208D00000X, 2085N0904X
MA44407208D00000X, 2085R0202X, 2085N0904X, 2085R0202X, 208D00000X
CAG471972085R0202X, 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