=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295186153
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SIRAJUM MUNIRA M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2016
-----------------------------------------------------
Last Update Date | 03/31/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 510 UPPER CHESAPEAKE DR STE 413
-----------------------------------------------------
City | BEL AIR
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21014-4328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-897-1941
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 166 DEFENSE HWY STE 200
-----------------------------------------------------
City | ANNAPOLIS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21401-8922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 108-971-9414
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | D0087789
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------