MEDICARE: MONICA JEAN ERCEG NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0024160921	VA
2	363LF0000X	Family Nurse Practitioner	R150861	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00901614	OTHER	MD	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6115533	OTHER	MD	AETNA HMO
2	225452	OTHER	MD	JHHC PROVIDER NUMBER
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	9738441	OTHER	MD	AETNA PPO
6	947077-01	OTHER	MD	CAREFIRST MD RENDERING PROVIDER NUMBER
7	7605-0101	OTHER	MD	CAREFIRST BLUECHOICE RENDERING PROVIDER NUMBER

General Provider Information

NPI Number	:	1134245251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA JEAN ERCEG NP

Provider Business Mailing Address
First Line	:	1111 BENFIELD BLVD
Second Line	:	SUITE 200
City	:	MILLERSVILLE
State	:	MD
Zip	:	21108-3002
Country	:	US
Telephone Number	:	410-729-5100
Fax Number	:	410-729-5156

Provider Business Practice Location Address
First Line	:	24 A MAGOTHY BEACH ROAD
Second Line	:
City	:	PASADENA
State	:	MD
Zip	:	21122-6837
Country	:	US
Telephone Number	:	410-255-2700
Fax Number	:	410-437-1962

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	05/22/2012

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Directions to “ MONICA JEAN ERCEG NP” Practice Location

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