Provider Demographics
NPI:1053355834
Name:ISMAIL, MONA S (MD)
Entity type:Individual
Prefix:DR
First Name:MONA
Middle Name:S
Last Name:ISMAIL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:559 MUSKET BAY DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-5421
Mailing Address - Country:US
Mailing Address - Phone:347-690-0881
Mailing Address - Fax:
Practice Address - Street 1:559 MUSKET BAY DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-5421
Practice Address - Country:US
Practice Address - Phone:917-455-8691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2020-040742084P0800X, 2084P0804X
NJ25MA075823002084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02395715Medicaid
NJ09969UT7Medicare ID - Type Unspecified
NY3X17515881Medicare ID - Type Unspecified
NY02395715Medicaid
NJ63929Medicare UPIN