Provider Demographics
NPI:1477533065
Name:MONCLA, PAUL R (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:R
Last Name:MONCLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 N ROAD ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3354
Mailing Address - Country:US
Mailing Address - Phone:252-338-0101
Mailing Address - Fax:252-331-1598
Practice Address - Street 1:1141 N ROAD ST
Practice Address - Street 2:SUITE I
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3354
Practice Address - Country:US
Practice Address - Phone:252-338-0101
Practice Address - Fax:252-331-1598
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9901580207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC56-1474922OtherTRICARE / CHAMPUS PROV #
NC5900947Medicaid
NCE3607OtherMEDCOST PROVIDER NUMBER
NC139K3OtherBC/BS OF NC PROVIDER #
NC139K3OtherBC/BS OF NC PROVIDER #
NCI37109Medicare UPIN