MEDICARE: MARTHA R. MUNDY AU.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	231H00000X	Audiologist		NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	904	OTHER	NC	NCHADLB

General Provider Information

NPI Number	:	1821099284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA R. MUNDY AU.D.

Provider Business Mailing Address
First Line	:	4915 MONTVALE DR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27705-4932
Country	:	US
Telephone Number	:	919-493-5436
Fax Number	:

Provider Business Practice Location Address
First Line	:	CAMPUS BOX 7190 WING D MEDICAL SCHOOL
Second Line	:	UNIVERSITY OF NORTH CAROLINA
City	:	CHAPEL HILL
State	:	NC
Zip	:	27599-0001
Country	:	US
Telephone Number	:	919-966-9457
Fax Number	:	919-966-0100

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/08/2007

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