1871925958 NPI number — DR. MONICA SHEA CROMER

Table of content: DR. MONICA SHEA CROMER (NPI 1871925958)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871925958 NPI number — DR. MONICA SHEA CROMER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROMER
Provider First Name:
MONICA
Provider Middle Name:
SHEA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871925958
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
131 MALLARD LAKE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AIKEN
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29803-7693
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-443-4017
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 SOCIETY HILL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AIKEN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29803-1731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-226-0104
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/31/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835X0200X , with the licence number:  12820 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1835X0200X , with the licence number: 024893 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)