Provider Demographics
NPI:1609800374
Name:STALLWORTH-KOLIMAS, MONICA (MD, MA, MPH, MM)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:STALLWORTH-KOLIMAS
Suffix:
Gender:F
Credentials:MD, MA, MPH, MM
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:STALLWORTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1500 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-3112
Mailing Address - Country:US
Mailing Address - Phone:301-745-4748
Mailing Address - Fax:301-745-4789
Practice Address - Street 1:1500 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-3112
Practice Address - Country:US
Practice Address - Phone:301-745-4748
Practice Address - Fax:301-745-4789
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216220207Q00000X
MDD0052781284300000X
PAMD468336207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No284300000XHospitalsSpecial Hospital