Basic Information
| Provider Information | |||||||||
| NPI: | 1164624342 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MONY | ||||||||
| FirstName: | CHITRA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 MICCOSUKEE ROAD | ||||||||
| Address2: | HOSPITALISTS GROUP | ||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504314556 | ||||||||
| FaxNumber: | 8504316315 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 MICCOSUKEE ROAD | ||||||||
| Address2: | HOSPITALISTS GROUP | ||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504314556 | ||||||||
| FaxNumber: | 8504316315 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2007 | ||||||||
| LastUpdateDate: | 11/15/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME102438 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 145UV | 01 | FL | FLORIDA BLUE | OTHER | 000612100 | 05 | FL | MEDICAID |