Provider Demographics
NPI:1124414164
Name:MONTI, RICHARD A JR (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:MONTI
Suffix:JR
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 1:3020 HAMAKER CT STE 400
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2231
Mailing Address - Country:US
Mailing Address - Phone:703-876-0800
Mailing Address - Fax:703-876-0866
Practice Address - Street 1:3020 HAMAKER CT STE 400
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2231
Practice Address - Country:US
Practice Address - Phone:703-876-0800
Practice Address - Fax:703-876-0866
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012695182084N0600X, 2084N0400X, 2084N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101269518OtherVIRGINIA MEDICAL LICENSE