Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | OS004229L | PA |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 02004229L | PA |
NPI | 1124036827 |
---|---|
Provider Name | Dr. Thomas Monahan |
First Address | Philadelphia, PA 19122-1721 |
Second Address | Philadelphia, PA 19122-1721 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 25/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I51210 | (02) | PA |