Provider Demographics
NPI:1174523567
Name:CHUMPITAZI, BRUNO ABILIO (MD)
Entity type:Individual
Prefix:
First Name:BRUNO
Middle Name:ABILIO
Last Name:CHUMPITAZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10409 BIT AND SPUR LN
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-1505
Mailing Address - Country:US
Mailing Address - Phone:301-593-7136
Mailing Address - Fax:301-593-4941
Practice Address - Street 1:11031 LOCKWOOD DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4532
Practice Address - Country:US
Practice Address - Phone:301-593-7136
Practice Address - Fax:301-593-4941
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0020704207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB94234Medicare UPIN
MD178048Medicare ID - Type Unspecified