Provider Demographics
NPI:1245393776
Name:FOX, MONIQUE HOPE (DO)
Entity type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:HOPE
Last Name:FOX
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5158
Mailing Address - Street 2:REGENESIS HEALTH CARE
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304
Mailing Address - Country:US
Mailing Address - Phone:864-582-2411
Mailing Address - Fax:864-582-7179
Practice Address - Street 1:750 SOUTH CHURCH STREET
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306
Practice Address - Country:US
Practice Address - Phone:864-582-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC968208000000X
SC962208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC009680Medicaid
I07028Medicare UPIN