Provider Demographics
NPI:1689715724
Name:MONAC, JOYCE ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:ELIZABETH
Last Name:MONAC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 GAR HWY
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-3935
Mailing Address - Country:US
Mailing Address - Phone:508-379-9605
Mailing Address - Fax:509-379-9813
Practice Address - Street 1:2200 GAR HWY
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-3935
Practice Address - Country:US
Practice Address - Phone:508-379-9605
Practice Address - Fax:509-379-9813
Is Sole Proprietor?:No
Enumeration Date:2007-02-10
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA52530208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI00413OtherEDS
MA9732951Medicaid
MAE01833Medicare UPIN
MA9732951Medicare ID - Type Unspecified