Active NPI
Monick Fanba
- Medical Physician Assistant
- Upper Marlboro, MD
National Provider Identifier
1093196990
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- C0005761
- Practice address
- 2502 Moores Plains Blvd
Upper Marlboro, MD 20774-8027 - Phone
- (240) 510-5218
- NPI assigned
- Jun 16, 2015
- Last updated
- Jun 16, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | C0005761 | MD | Primary |
Addresses
Primary practice location
2502 Moores Plains Blvd
Upper Marlboro, MD 20774-8027
Mailing address
2502 Moores Plains Blvd
Upper Marlboro, MD 20774-8027
Phone (240) 510-5218
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C0005761 | MD | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1434412800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1434412800000",
"number": "1093196990",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2502 MOORES PLAINS BLVD",
"city": "UPPER MARLBORO",
"state": "MD",
"postal_code": "207748027",
"telephone_number": "240-510-5218"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2502 MOORES PLAINS BLVD",
"city": "UPPER MARLBORO",
"state": "MD",
"postal_code": "207748027",
"telephone_number": "240-510-5218"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FANBA",
"first_name": "MONICK",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-06-16",
"last_updated": "2015-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "MD",
"license": "C0005761",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Upper Marlboro, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.