Healthcare Provider Details

I. General information

NPI: 1093031684
Provider Name (Legal Business Name): NICHOLAS C MONU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3949 BROWNING PL
RALEIGH NC
27609-6536
US

IV. Provider business mailing address

KAISER PERMANENTE 700 2ND ST NE
WASHINGTON DC
20002
US

V. Phone/Fax

Practice location:
  • Phone: 919-787-7411
  • Fax: 919-789-4461
Mailing address:
  • Phone: 202-346-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2016-00441
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: