Provider Demographics
NPI:1164624342
Name:MONY, CHITRA (MD)
Entity Type:Individual
Prefix:
First Name:CHITRA
Middle Name:
Last Name:MONY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 MICCOSUKEE ROAD
Mailing Address - Street 2:HOSPITALISTS GROUP
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308
Mailing Address - Country:US
Mailing Address - Phone:850-431-4556
Mailing Address - Fax:850-431-6315
Practice Address - Street 1:1300 MICCOSUKEE ROAD
Practice Address - Street 2:HOSPITALISTS GROUP
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:850-431-4556
Practice Address - Fax:850-431-6315
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102438207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL145UVOtherFLORIDA BLUE
FL000612100Medicaid
FLDA853ZMedicare Oscar/Certification