Provider Demographics
NPI:1235977323
Name:MONROE, JOHNATHAN LEWIS III
Entity type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:LEWIS
Last Name:MONROE
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 SEMINOLE CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-3572
Mailing Address - Country:US
Mailing Address - Phone:240-695-2513
Mailing Address - Fax:
Practice Address - Street 1:2918 MINNESOTA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-1127
Practice Address - Country:US
Practice Address - Phone:240-695-2513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator