Provider Demographics
NPI:1992789499
Name:MONICO, EDWARD P (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:P
Last Name:MONICO
Suffix:
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 1:20 YORK ST
Mailing Address - Street 2:YNHH SOUTH PAVILION - ROOM 218
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3220
Mailing Address - Country:US
Mailing Address - Phone:203-688-2222
Mailing Address - Fax:203-785-4580
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:YNHH SOUTH PAVILION - ROOM 218
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-688-2222
Practice Address - Fax:203-785-4580
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT032929207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001329293Medicaid
CT930000296Medicare ID - Type Unspecified
CT001329293Medicaid