Provider Demographics
NPI:1043294564
Name:MONTANARELLA, MARY JO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY JO
Middle Name:
Last Name:MONTANARELLA
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 1:30 CANTON ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-3524
Mailing Address - Country:US
Mailing Address - Phone:603-624-1638
Mailing Address - Fax:603-624-1972
Practice Address - Street 1:30 CANTON ST
Practice Address - Street 2:SUITE 6
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3524
Practice Address - Country:US
Practice Address - Phone:603-624-1638
Practice Address - Fax:603-624-1972
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8358207V00000X, 207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH165135OtherBLUE CHOICE/HMO BLUE/INDE
NH2950237OtherHMO(QUALITY POS, US ACCES
0702141OtherDIRECT ACCESS
NH141852219OtherUNITED HEALTHCARE
NH2755OtherHEALTHSOURCE
NH3072647Medicaid
NH141852219OtherCIGNA
NH0105135Y0NH01OtherANTHEM
NH141852219OtherHCVM
NH759308OtherTUFTS
NHE55310OtherHARVARD PILGRIM
NHNX1984OtherPTAN
NH141852219OtherUNICARE
NH141852219OtherONE HEALTH PLAN
NH141852219OtherPHCS
NH141852219OtherUNITED HEALTHCARE