Provider Demographics
NPI:1528067014
Name:MONIZ, MARK PHILLIP (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:PHILLIP
Last Name:MONIZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:856 J CLYDE MORRIS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-316-5800
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:120 KINGS WAY STE 2600
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2554
Practice Address - Country:US
Practice Address - Phone:757-345-0141
Practice Address - Fax:757-206-1291
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2021-11-03
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Provider Licenses
StateLicense IDTaxonomies
VA0101058407208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007311885Medicaid
020001436Medicare ID - Type Unspecified
VA007311885Medicaid