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General NPI Number Information
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NPI Number | 1972689883
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Entity Type | Individual
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Provider Name | ALBERT JOSEPH MUNGO MD
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Gender | Male
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2204 WILBORN AVENUE HALIFAX REGIONAL HOSPITAL
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City | HALIFAX
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State | VA
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Zip | 24592
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Country | US
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Telephone | 434-517-3187
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Fax | 434-517-3686
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Provider Business Mailing Address
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Address Line | PO BOX 340
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City | HALIFAX
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State | VA
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Zip | 24558
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Country | US
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Telephone | 434-575-1683
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Fax | 434-575-1682
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 0101235169
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License Number State | VA
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