Provider Demographics
NPI:1578649299
Name:MONSOUR, ROY CHRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:CHRISTOPHER
Last Name:MONSOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 DAKOTA LN
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658-3617
Mailing Address - Country:US
Mailing Address - Phone:724-454-5586
Mailing Address - Fax:724-454-5586
Practice Address - Street 1:119 DAKOTA LN
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658-3617
Practice Address - Country:US
Practice Address - Phone:724-454-5586
Practice Address - Fax:724-454-5586
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038199E2084A0401X, 2084P0800X, 2084P0802X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC34818Medicare UPIN