Provider Demographics
NPI:1164537213
Name:MONTILEONE, MICHAEL SALVATORE (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SALVATORE
Last Name:MONTILEONE
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 12127
Mailing Address - Street 2:TIDEWATER DIAGNOSTIC IMAGING
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23612-2121
Mailing Address - Country:US
Mailing Address - Phone:757-867-6101
Mailing Address - Fax:757-867-6587
Practice Address - Street 1:100 SENTARA CIRCLE
Practice Address - Street 2:SENTARA WILLIAMSBURG REGIONAL MEDICAL CENTER
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188
Practice Address - Country:US
Practice Address - Phone:757-984-7890
Practice Address - Fax:757-984-7891
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01012304462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7204868Medicaid
VA7204868Medicaid
H58261Medicare UPIN