Provider Demographics
NPI:1033216015
Name:MONTANARO, ANTHONY J (DO)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:MONTANARO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 4TH AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-5949
Mailing Address - Country:US
Mailing Address - Phone:941-527-0259
Mailing Address - Fax:941-527-0263
Practice Address - Street 1:1533 4TH AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-5949
Practice Address - Country:US
Practice Address - Phone:941-527-0259
Practice Address - Fax:941-527-0263
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003927M207Q00000X
FLOS9181207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0596645Medicaid
FL278906000Medicaid
OH0596645Medicaid