MEDICARE: DR. MONA TALEB MD/PHD

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	208600000X	Surgery Physician	277288	MA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	208600000X	Surgery Physician	55228	CT
4	208600000X	Surgery Physician	0101275053	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14351923	OTHER		CAQH
2	4301505224	OTHER	MI	MICHIGAN STATE MEDICAL LICENSE
3	55228	OTHER	CT	CONNECTICUT STATE MEDICAL LICENSE
4	0101275053	OTHER	VA	VA MEDICAL LICENSE

General Provider Information

NPI Number	:	1023306875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MONA TALEB MD/PHD

Provider Business Mailing Address
First Line	:	222 HARRISON RD
Second Line	:
City	:	CHESHIRE
State	:	CT
Zip	:	06410-3569
Country	:	US
Telephone Number	:	786-553-7047
Fax Number	:

Provider Business Practice Location Address
First Line	:	935 S MAIN ST
Second Line	:
City	:	FARMVILLE
State	:	VA
Zip	:	23901-2211
Country	:	US
Telephone Number	:	434-315-5340
Fax Number	:

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

Provider Enumeration Date	:	07/14/2011
Last Update Date	:	12/19/2025

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