Healthcare Provider Details

I. General information

NPI: 1568305076
Provider Name (Legal Business Name): MS. PEGGY G MUUNGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14729 4TH ST UNIT 128
LAUREL MD
20707-3998
US

IV. Provider business mailing address

14729 4TH ST UNIT 128
LAUREL MD
20707-3998
US

V. Phone/Fax

Practice location:
  • Phone: 240-423-4912
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: