Provider Demographics
NPI:1386695807
Name:MILES, MONICA L (MD)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:L
Last Name:MILES
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 1:680 CENTRE STREET
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-3395
Mailing Address - Country:US
Mailing Address - Phone:508-941-7000
Mailing Address - Fax:508-941-6337
Practice Address - Street 1:680 CENTRE STREET
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3395
Practice Address - Country:US
Practice Address - Phone:508-941-7000
Practice Address - Fax:508-941-6337
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN477292084P0800X
MA2432592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN911458100Medicaid
MN260002484Medicare ID - Type Unspecified
MN911458100Medicaid