Basic Information
| Provider Information | |||||||||
| NPI: | 1053639831 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIX | ||||||||
| FirstName: | MONICA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 E EAGER ST | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212025533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105229800 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1000 E EAGER ST | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212025533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105229800 | ||||||||
| FaxNumber: | 4105225138 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2010 | ||||||||
| LastUpdateDate: | 06/09/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2327 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 2327 | MD | N | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.