Provider Demographics
NPI:1699002451
Name:DOUGLAS, MONICA C
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:C
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ANESTHESIOLOGY AND CRITICAL CARE MEDICINE
Mailing Address - Street 2:600 N. WOLFE STREET/ BLALOCK 1415
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0001
Mailing Address - Country:US
Mailing Address - Phone:410-955-8408
Mailing Address - Fax:410-955-4858
Practice Address - Street 1:ANESTHESIOLOGY AND CRITICAL CARE MEDICINE
Practice Address - Street 2:600 N. WOLFE STREET/ BLALOCK 1415
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0001
Practice Address - Country:US
Practice Address - Phone:410-955-8408
Practice Address - Fax:410-955-4858
Is Sole Proprietor?:No
Enumeration Date:2009-11-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR161917367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD030258900Medicaid
MD030258900Medicaid