Provider Demographics
NPI:1669689881
Name:STAUFFER-MUNEKATA, CAROL ANN (MD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANN
Last Name:STAUFFER-MUNEKATA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MEADOW SPRING DR
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-1700
Mailing Address - Country:US
Mailing Address - Phone:410-734-6613
Mailing Address - Fax:
Practice Address - Street 1:1206-B EXPRESSCARE OF BEL AIR
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014
Practice Address - Country:US
Practice Address - Phone:410-838-2301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0036939207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine