Provider Demographics
NPI:1033112966
Name:MONTEFERRANTE, JUDITH (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:
Last Name:MONTEFERRANTE
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 1:45 EASTERN POINT RD
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-4139
Mailing Address - Country:US
Mailing Address - Phone:978-283-6856
Mailing Address - Fax:978-282-0977
Practice Address - Street 1:45 EASTERN POINT RD
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-4139
Practice Address - Country:US
Practice Address - Phone:978-283-6856
Practice Address - Fax:978-282-0977
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138569174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00832559Medicaid
NY060065457OtherRAIL ROAD MEDICARE
NY00832559Medicaid
NY18D351Medicare ID - Type Unspecified
NYB10551Medicare UPIN