Provider Demographics
NPI:1396772497
Name:MONROY, NELSON G (MD)
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:G
Last Name:MONROY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4099 FOXWOOD DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-5222
Mailing Address - Country:US
Mailing Address - Phone:888-695-9740
Mailing Address - Fax:888-695-9760
Practice Address - Street 1:4099 FOXWOOD DR
Practice Address - Street 2:SUITE 203
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-5222
Practice Address - Country:US
Practice Address - Phone:888-695-9740
Practice Address - Fax:888-695-9760
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012319472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010206669Medicaid
VAI12514Medicare UPIN
VA190001372Medicare ID - Type Unspecified