Provider Demographics
NPI:1134245251
Name:ERCEG, MONICA JEAN (NP)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:JEAN
Last Name:ERCEG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 BENFIELD BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-3002
Mailing Address - Country:US
Mailing Address - Phone:410-729-5100
Mailing Address - Fax:410-729-5156
Practice Address - Street 1:24 A MAGOTHY BEACH ROAD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-6837
Practice Address - Country:US
Practice Address - Phone:410-255-2700
Practice Address - Fax:410-437-1962
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024160921363LF0000X
MDR150861363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6115533OtherAETNA HMO
MD225452OtherJHHC PROVIDER NUMBER
MDP00901614OtherRAILROAD MEDICARE
MD416732500Medicaid
MD9738441OtherAETNA PPO
MD947077-01OtherCAREFIRST MD RENDERING PROVIDER NUMBER
MD7605-0101OtherCAREFIRST BLUECHOICE RENDERING PROVIDER NUMBER
MD9738441OtherAETNA PPO