Healthcare Provider Details

I. General information

NPI: 1265533665
Provider Name (Legal Business Name): MONJARI GILLIAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17310 WRIGHT ST STE 103
OMAHA NE
68130-2405
US

IV. Provider business mailing address

PO BOX 79537
BALTIMORE MD
21279-0537
US

V. Phone/Fax

Practice location:
  • Phone: 833-228-6889
  • Fax: 877-853-0376
Mailing address:
  • Phone: 703-824-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number16949
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2020033732
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101840567
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036154541
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: