Provider Demographics
NPI:1316919632
Name:MONROE, GEORGE C III (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:C
Last Name:MONROE
Suffix:III
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 1:707 MEMORIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2975
Mailing Address - Country:US
Mailing Address - Phone:704-403-7050
Mailing Address - Fax:704-403-7059
Practice Address - Street 1:707 MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2975
Practice Address - Country:US
Practice Address - Phone:704-403-7050
Practice Address - Fax:704-403-7059
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23216207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC232009OtherMEDICARE
NC8960053Medicaid
NC28297OtherMEDCOST
NC14363OtherPARTNERS MEDICARE CHOICE
NC4324669OtherAETNA
NC60053OtherBCBS NC
NC208959DMedicare PIN
NC8960053Medicaid
NC4324669OtherAETNA