Provider Demographics
NPI:1982692729
Name:MUNGO, DAVID V (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:V
Last Name:MUNGO
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 2718
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-0718
Mailing Address - Country:US
Mailing Address - Phone:330-596-6500
Mailing Address - Fax:330-596-6505
Practice Address - Street 1:1900 S UNION AVE # 100
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-4355
Practice Address - Country:US
Practice Address - Phone:330-596-6500
Practice Address - Fax:330-596-6505
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35077515-M207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2191159Medicaid
OH4020882Medicare PIN
OHH-16159Medicare UPIN
OH341089680OtherCIGNA
OH341089680OtherPPO NEXT
OH341089680029OtherCARESOURCE
OHH-16159Medicare UPIN
OH000000126981OtherANTHEM
OH341089680OtherFIRST HEALTH
OH341089680OtherDIRECT CARE AMERICA
OH341089680OtherUNITED HEALTHCARE
OH7354227OtherAETNA
OH341089680OtherUNITED HEALTH CARE
OH733349OtherBUCKEYE HEALTH PLAN
OH341089680OtherAULTCARE
OH4020881Medicare ID - Type Unspecified
OH2191159Medicaid