Provider Demographics
NPI:1881092237
Name:MANTIA, MONICA
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:MANTIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 N GEORGE MASON DR STE 345
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3690
Mailing Address - Country:US
Mailing Address - Phone:703-717-4400
Mailing Address - Fax:703-717-4401
Practice Address - Street 1:1625 N GEORGE MASON DR STE 345
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3690
Practice Address - Country:US
Practice Address - Phone:703-717-4400
Practice Address - Fax:703-717-4401
Is Sole Proprietor?:No
Enumeration Date:2014-12-17
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA057333363A00000X
MDC0005651363A00000X
VA0110006478363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant