Provider Demographics
NPI:1477552883
Name:MONSOUR, ROY E (MD)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:E
Last Name:MONSOUR
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 1:409 S 2ND ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2025 TECHNOLOGY PKWY STE 301
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-9402
Practice Address - Country:US
Practice Address - Phone:717-642-5666
Practice Address - Fax:717-642-4292
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035202L207PE0005X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50076402OtherCAPITAL BLUE CROSS/KEYSTONE HEALTH PLAN
PA64768OtherGEISINGER HEALTH PLAN
PA000175361OtherHIGHMARK BLUE SHIELD
PA000962488Medicaid