Provider Demographics
NPI:1750597670
Name:TATARIA, MONIKA (MD)
Entity type:Individual
Prefix:
First Name:MONIKA
Middle Name:
Last Name:TATARIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3732 WIMBLETON DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2730
Mailing Address - Country:US
Mailing Address - Phone:650-996-1755
Mailing Address - Fax:
Practice Address - Street 1:3732 WIMBLETON DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35223-2730
Practice Address - Country:US
Practice Address - Phone:650-996-1755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL309282085R0202X, 2085R0202X
ALMD30928208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051118249OtherBCBS
AL051118251OtherBCBS
AL129399Medicaid
MS01056218Medicaid
AL051118250OtherBCBS
AL129391Medicaid
AL129395Medicaid
AL129402Medicaid
AL051118255OtherBCBS
AL102I308578OtherMEDICARE
AL129398Medicaid
AL129404Medicaid
ALZ17051OtherVIVA
AL051118248OtherBCBS
AL129392Medicaid
AL129403Medicaid
AL051118252OtherBCBS
AL051118254OtherBCBS
AL051118256OtherBCBS
AL129405Medicaid
AL51124835OtherBLUE CROSS PMD
AL051118242OtherBCBS
AL129400Medicaid
AL51124834OtherBLUE CROSS PMD
AL051118253OtherBCBS
AL51124836OtherBLUE CROSS PMD
AL051118252OtherBCBS