Provider Demographics
NPI:1447295506
Name:FORTH, MONICA J (MD)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:J
Last Name:FORTH
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 1:3000 WATERCOVE RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-3982
Mailing Address - Country:US
Mailing Address - Phone:804-744-0200
Mailing Address - Fax:804-744-8417
Practice Address - Street 1:3000 WATERCOVE RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-3982
Practice Address - Country:US
Practice Address - Phone:804-744-0200
Practice Address - Fax:804-744-8417
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237957207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7114703OtherAETNA LIFE
VA325300OtherSOUTHERN HEALTH SERVICES
VA2138651OtherMAMSI
VA8496189OtherCIGNA
VA99400OtherSENTARA
VAC04469OtherGROUP PTAN
C06695OtherGROUP PTAN
VA010199638Medicaid
VA1135090OtherAETNA HMO
VA184315OtherANTHEM BCBS OF VA
VAC06115OtherGROUP PTAN
VAC06734OtherGROUP PTAN
VAC06778OtherGROUP PTAN
VA184315OtherANTHEM BCBS OF VA
VAC06115OtherGROUP PTAN