Provider Demographics
NPI:1821098518
Name:MONROE, ALLISON LEACH (MD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:LEACH
Last Name:MONROE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:MICHELLE
Other - Last Name:LEACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 612228
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96152-2228
Mailing Address - Country:US
Mailing Address - Phone:530-542-2855
Mailing Address - Fax:
Practice Address - Street 1:2155 SOUTH AVE
Practice Address - Street 2:STE 30
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-7038
Practice Address - Country:US
Practice Address - Phone:530-542-5740
Practice Address - Fax:530-542-5743
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86075207Q00000X
ME016048207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H90429Medicare UPIN
H90429Medicare ID - Type Unspecified