Healthcare Provider Details

I. General information

NPI: 1861622532
Provider Name (Legal Business Name): MONIQUE A. GARY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2009
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 LAWN AVE SUITE 203
SELLERSVILLE PA
18960-1551
US

IV. Provider business mailing address

PO BOX 1111
HARLEYSVILLE PA
19438-0907
US

V. Phone/Fax

Practice location:
  • Phone: 215-453-3400
  • Fax: 215-453-3410
Mailing address:
  • Phone: 215-453-4995
  • Fax: 215-453-4646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOS017837
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number241533
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberDO034482
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: