Provider Demographics
NPI:1053371385
Name:MUNDA, PATRICIA JUMA (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:JUMA
Last Name:MUNDA
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:TAN & CHESTNUT ST FREDERICKSBURG COMMUNITY HEALTH CENTE
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17026-0009
Mailing Address - Country:US
Mailing Address - Phone:717-865-6644
Mailing Address - Fax:717-865-7321
Practice Address - Street 1:TAN & CHESTNUT STREETS
Practice Address - Street 2:FREDERICKSBURG COMMUNITY HEALTH CENTER PC
Practice Address - City:FREDERICKSBURG
Practice Address - State:PA
Practice Address - Zip Code:17026-0009
Practice Address - Country:US
Practice Address - Phone:717-865-6644
Practice Address - Fax:717-865-7321
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD06794L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001750533Medicaid
PA01920701OtherBLUE CROSS
PA0554465OtherBLUE SHIELD
PA0554465OtherBLUE SHIELD
G94817Medicare UPIN