Provider Demographics
NPI:1740249085
Name:MCMONIGAL, CHRISTIAN O JR (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:O
Last Name:MCMONIGAL
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:COUDERSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16915-8161
Mailing Address - Country:US
Mailing Address - Phone:814-274-9300
Mailing Address - Fax:
Practice Address - Street 1:71 ELK ST
Practice Address - Street 2:
Practice Address - City:COUDERSPORT
Practice Address - State:PA
Practice Address - Zip Code:16915-9601
Practice Address - Country:US
Practice Address - Phone:814-274-5577
Practice Address - Fax:814-274-8709
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052309363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1069453OtherNCCPA NUMBER
PAQ66951Medicare UPIN
PA099802Medicare ID - Type Unspecified