Provider Demographics
NPI:1508971680
Name:MONROE, BRIAN JOSEPH (CPO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JOSEPH
Last Name:MONROE
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 24TH ST NW STE 5
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-2543
Mailing Address - Country:US
Mailing Address - Phone:202-338-0770
Mailing Address - Fax:202-315-3176
Practice Address - Street 1:730 24TH ST NW STE 5
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2543
Practice Address - Country:US
Practice Address - Phone:202-338-0770
Practice Address - Fax:202-315-3176
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1705224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010232775Medicaid
DC1030109OtherACM
DC4417OtherCAREFIRST BCBS
MD409782300Medicaid
DC037399700Medicaid
DC1030109OtherACM