Individual
MONIQUE CHERIE MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
10710 CHARTER DR STE 300, COLUMBIA, MD 21044-3260
(410) 644-1880
(410) 730-1617
Mailing address
10710 CHARTER DR STE 300, COLUMBIA, MD 21044-3260
(410) 644-1880
(410) 730-1617
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C04570
MD
363AM0700X
Medical Physician Assistant
C0004570
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
257075
JHHC
MD
01
—
8367541
AETNA HMO
MD
01
—
9253775
AETNA PPO
MD
Enumeration date
10/25/2011
Last updated
09/01/2019
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