Provider Demographics
NPI:1114189149
Name:LEE, MONIKA G (MD)
Entity Type:Individual
Prefix:
First Name:MONIKA
Middle Name:G
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MONIKA
Other - Middle Name:
Other - Last Name:GARG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23130 MOAKLEY ST
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-2918
Mailing Address - Country:US
Mailing Address - Phone:301-997-0611
Mailing Address - Fax:301-997-0709
Practice Address - Street 1:23130 MOAKLEY ST
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2918
Practice Address - Country:US
Practice Address - Phone:301-997-0611
Practice Address - Fax:301-997-0709
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0047849207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF26934Medicare UPIN