Provider Demographics
NPI:1740625920
Name:BRUNO A. CHUMPITAZI M.D. P.C.
Entity type:Organization
Organization Name:BRUNO A. CHUMPITAZI M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUNO
Authorized Official - Middle Name:ABILIO
Authorized Official - Last Name:CHUMPITAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-593-7136
Mailing Address - Street 1:11031 LOCKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4532
Mailing Address - Country:US
Mailing Address - Phone:301-593-7136
Mailing Address - Fax:301-593-4941
Practice Address - Street 1:11031 LOCKWOOD DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4532
Practice Address - Country:US
Practice Address - Phone:301-593-7136
Practice Address - Fax:301-593-4941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0020704207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B93453Medicare UPIN
B94234Medicare UPIN