MEDICARE: DR. KHIN RUPPA WADDY MAUNG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	D0056468	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	S190/ 0046	OTHER	MD	BLUE CHOICE
2	KF68/ 609776-02	OTHER	MD	BC/BS OF MD

General Provider Information

NPI Number	:	1083652622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KHIN RUPPA WADDY MAUNG M.D.

Provider Business Mailing Address
First Line	:	PO BOX 62026
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21264-2026
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 N ROLLING RD
Second Line	:
City	:	CATONSVILLE
State	:	MD
Zip	:	21228-3826
Country	:	US
Telephone Number	:	410-744-8822
Fax Number	:	410-744-5117

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	07/08/2007

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