MEDICARE: INNOCENT MONYA-TAMBI MD

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	207R00000X	Internal Medicine Physician	FM4237942	MD
2	207R00000X	Internal Medicine Physician	FM3900518	VA
3	207R00000X	Internal Medicine Physician	265253	NY
4	207R00000X	Internal Medicine Physician	MD448694	PA
5	207R00000X	Internal Medicine Physician	M80945	MD
6	207R00000X	Internal Medicine Physician	D0076463	MD
7	207R00000X	Internal Medicine Physician	FM4310683	PA
8	207R00000X	Internal Medicine Physician	0101254880	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	265253	OTHER	NY	MEDICAL LICENSE
2	MD448694	OTHER	PA	MEDICAL LICENSE
3	0101254880	OTHER	VA	MEDICAL LICENSE
4	M80945	OTHER	MD	CONTROLLED SUBSTANCE LICENSE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	D0076463	OTHER	MD	MEDICAL LICENSE

General Provider Information

NPI Number	:	1386829679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INNOCENT MONYA-TAMBI MD

Provider Business Mailing Address
First Line	:	1709 ROSEMONT AVE
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21702-4135
Country	:	US
Telephone Number	:	301-624-5999
Fax Number	:	301-624-5997

Provider Business Practice Location Address
First Line	:	1709 ROSEMONT AVE
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21702-4135
Country	:	US
Telephone Number	:	301-624-5999
Fax Number	:	301-624-5997

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

Provider Enumeration Date	:	01/04/2008
Last Update Date	:	03/07/2023

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