Provider Demographics
NPI:1790106607
Name:CHIANG, MONICA CARMEN (MD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:CARMEN
Last Name:CHIANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:DEL CARMEN
Other - Last Name:CHIANG CARBONELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:300 SOUTH GREENO ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532
Mailing Address - Country:US
Mailing Address - Phone:251-929-3424
Mailing Address - Fax:
Practice Address - Street 1:300 SOUTH GREENO ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532
Practice Address - Country:US
Practice Address - Phone:251-929-3424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-18
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL35126207RE0101X
LA207019261QM1300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty