Provider Demographics
NPI:1881763209
Name:MONGE-MEBERG, PATRICIA KATHLEEN (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:KATHLEEN
Last Name:MONGE-MEBERG
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:PO BOX 1599
Mailing Address - Street 2:
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482-1599
Mailing Address - Country:US
Mailing Address - Phone:804-435-3103
Mailing Address - Fax:804-435-6695
Practice Address - Street 1:107 DMV DRIVE
Practice Address - Street 2:
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482
Practice Address - Country:US
Practice Address - Phone:804-435-3103
Practice Address - Fax:804-435-6695
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234515207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA136844OtherANTHEM
VA244253OtherSOUTHERN HEALTH
VA010060567Medicaid
VA76557OtherSENTARA MEDICAID NUMBER
VA7867546OtherAETNA
VA7867546OtherAETNA
VA76557OtherSENTARA MEDICAID NUMBER