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NPI Code Detail

MEDICARE: JOHN MONROE JR. MD

MEDICARE: JOHN MONROE JR. 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
1207Q00000XFamily Medicine Physician033009CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508863226
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN MONROE JR. MD
Provider Business Mailing Address
First Line : 575 MAIN ST 2ND FLOOR
Second Line : ATTN: CREDENTIALING DEPARTMENT
City : MIDDLETOWN
State : CT
Zip : 06457-2718
Country : US
Telephone Number : 860-347-6971
Fax Number :
Provider Business Practice Location Address
First Line : 1 SHAWS CV
Second Line :
City : NEW LONDON
State : CT
Zip : 06320-4902
Country : US
Telephone Number : 860-447-8304
Fax Number : 860-443-8720
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 12/06/2013

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