1639132939 NPI number — DR. MIROYA J MONSOUR M.D.

Table of content: DR. MIROYA J MONSOUR M.D. (NPI 1639132939)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639132939 NPI number — DR. MIROYA J MONSOUR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONSOUR
Provider First Name:
MIROYA
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1639132939
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1075 HARRISON CITY EXPORT RD
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
JEANNETTE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15644-4309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-744-4009
Provider Business Mailing Address Fax Number:
724-744-2065

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1075 HARRISON CITY-EXPORT ROAD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
JEANNETTE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-744-4009
Provider Business Practice Location Address Fax Number:
724-744-2065
Provider Enumeration Date:
04/08/2006

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: 207W00000X , with the licence number:  MD047489L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0013906530005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5036640001 . This is a "MEDICARE P-TAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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