Provider Demographics
NPI:1902244411
Name:MALDONADO, MONICA (NP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 DEFENSE HWY STE 150
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-8953
Mailing Address - Country:US
Mailing Address - Phone:434-815-3104
Mailing Address - Fax:443-481-6516
Practice Address - Street 1:2000 MEDICAL PKWY STE 309
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-224-1133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR231216363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0387622Medicaid
MDK5820009OtherCAREFIRST