Provider Demographics
NPI:1982640157
Name:DUVALL, MONICA (MD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:DUVALL
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 1:3819 CHESTNUT ST
Mailing Address - Street 2:STE 205
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3171
Mailing Address - Country:US
Mailing Address - Phone:215-662-8777
Mailing Address - Fax:215-615-4470
Practice Address - Street 1:3819 CHESTNUT ST
Practice Address - Street 2:STE 205
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-662-8777
Practice Address - Fax:215-615-4470
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424490207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012570480001Medicaid
PA082966Medicare ID - Type Unspecified
PA1012570480001Medicaid