Basic Information
| Provider Information | |||||||||
| NPI: | 1104016096 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEDHI | ||||||||
| FirstName: | MONISHA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 11676 PERRY HWY | ||||||||
| Address2: | SUITE 1308 | ||||||||
| City: | WEXFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150907201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249330155 | ||||||||
| FaxNumber: | 7249330833 | ||||||||
| Practice Location | |||||||||
| Address1: | 11676 PERRY HWY | ||||||||
| Address2: | SUITE 1308 | ||||||||
| City: | WEXFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150907201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249330155 | ||||||||
| FaxNumber: | 7249330833 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2007 | ||||||||
| LastUpdateDate: | 10/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD428279 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RE0101X | MD428279 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | 207RG0300X | MD428279 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 149037001 | 05 | AR | MEDICAID |