Healthcare Provider Details

I. General information

NPI: 1184143141
Provider Name (Legal Business Name): CHIEDZA MUPANOMUNDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9103 FRANKLIN SQUARE DR
BALTIMORE MD
21237-3900
US

IV. Provider business mailing address

9103 FRANKLIN SQUARE DR
BALTIMORE MD
21237-3900
US

V. Phone/Fax

Practice location:
  • Phone: 443-777-7000
  • Fax:
Mailing address:
  • Phone: 410-601-7639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number338680
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: