Provider Demographics
NPI:1013280916
Name:LEID, MONICA RENEE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:MONICA
Middle Name:RENEE
Last Name:LEID
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:RENEE
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 WALTER WARD BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-1286
Mailing Address - Country:US
Mailing Address - Phone:410-777-8971
Mailing Address - Fax:877-595-7180
Practice Address - Street 1:7501 GREENWAY CENTER DR STE 660
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-6700
Practice Address - Country:US
Practice Address - Phone:410-777-8971
Practice Address - Fax:877-595-7180
Is Sole Proprietor?:No
Enumeration Date:2012-02-23
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004455363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical