Individual
INNOCENT MONYA-TAMBI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1709 ROSEMONT AVE, FREDERICK, MD 21702-4135
(301) 624-5999
(301) 624-5997
Mailing address
1709 ROSEMONT AVE, FREDERICK, MD 21702-4135
(301) 624-5999
(301) 624-5997
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101254880
VA
207R00000X
Internal Medicine Physician
265253
NY
207R00000X
Internal Medicine Physician
D0076463
MD
207R00000X
Internal Medicine Physician
FM3900518
VA
207R00000X
Internal Medicine Physician
FM4237942
MD
207R00000X
Internal Medicine Physician
FM4310683
PA
207R00000X
Internal Medicine Physician
M80945
MD
207R00000X
Internal Medicine Physician
MD448694
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101254880
MEDICAL LICENSE
VA
05
—
1386829679
—
VA
01
—
265253
MEDICAL LICENSE
NY
01
—
D0076463
MEDICAL LICENSE
MD
01
—
M80945
CONTROLLED SUBSTANCE LICENSE
MD
01
—
MD448694
MEDICAL LICENSE
PA
05
—
Q012138
—
TN
Enumeration date
01/04/2008
Last updated
03/07/2023
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