MEDICARE: DR. KEITH D MUNSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	2020-03144	NC
2	174400000X	Specialist	0101223708	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942292503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH D MUNSON M.D.

Provider Business Mailing Address
First Line	:	4913 FAWN DELL RD
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-8624
Country	:	US
Telephone Number	:	540-314-5568
Fax Number	:

Provider Business Practice Location Address
First Line	:	4913 FAWN DELL RD
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-8624
Country	:	US
Telephone Number	:	540-314-5568
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	09/08/2021

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