Provider Demographics
NPI:1639132939
Name:MONSOUR, MIROYA J (MD)
Entity Type:Individual
Prefix:DR
First Name:MIROYA
Middle Name:J
Last Name:MONSOUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1075 HARRISON CITY EXPORT RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-4309
Mailing Address - Country:US
Mailing Address - Phone:724-744-4009
Mailing Address - Fax:724-744-2065
Practice Address - Street 1:1075 HARRISON CITY-EXPORT ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:JEANNETTE
Practice Address - State:PA
Practice Address - Zip Code:15644
Practice Address - Country:US
Practice Address - Phone:724-744-4009
Practice Address - Fax:724-744-2065
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD047489L207W00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0013906530005Medicaid
PA5036640001OtherMEDICARE P-TAN
PA5036640001OtherMEDICARE P-TAN
PA0013906530005Medicaid