Healthcare Provider Details

I. General information

NPI: 1679682215
Provider Name (Legal Business Name): MONTE PHILIP MAKOUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

U S DEPARTMENT OF STATE M/MED/QI, SA-1, 2501 E STREET NW
WASHINGTON DC
20522-0001
US

IV. Provider business mailing address

US DEPT OF STATE M MED QI 2401 E STREET NW
WASHINGTON DC
20522-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-663-1662
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-047102L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: