Healthcare Provider Details

I. General information

NPI: 1639132939
Provider Name (Legal Business Name): MIROYA J MONSOUR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 HARRISON CITY-EXPORT ROAD SUITE 1
JEANNETTE PA
15644
US

IV. Provider business mailing address

1075 HARRISON CITY EXPORT RD SUITE 1
JEANNETTE PA
15644-4309
US

V. Phone/Fax

Practice location:
  • Phone: 724-744-4009
  • Fax: 724-744-2065
Mailing address:
  • Phone: 724-744-4009
  • Fax: 724-744-2065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD047489L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: