Healthcare Provider Details

I. General information

NPI: 1518957976
Provider Name (Legal Business Name): KEVIN PETER MUNNELLY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20201 CENTURY BLVD STE 480 CHEVY CHASE ANESTHESIA LLC
GERMANTOWN MD
20874-1113
US

IV. Provider business mailing address

PO BOX 1510 CHEVY CHASE ANESTHESIA LLC
GERMANTOWN MD
20875-1510
US

V. Phone/Fax

Practice location:
  • Phone: 301-528-0222
  • Fax: 301-515-4153
Mailing address:
  • Phone: 301-528-0222
  • Fax: 301-515-4153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD0060410
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberD0060410
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: