Provider Demographics
NPI:1194835629
Name:MONTANARO, RAYMOND C (PA)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:C
Last Name:MONTANARO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HAGEN DR STE 220
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2658
Mailing Address - Country:US
Mailing Address - Phone:585-295-5302
Mailing Address - Fax:585-248-0567
Practice Address - Street 1:30 HAGEN DR STE 220
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2658
Practice Address - Country:US
Practice Address - Phone:585-295-5302
Practice Address - Fax:585-248-0567
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008722363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7754593OtherAETNA
NYP019008722OtherBLUE CHOICE
NYPA0309OtherPREFERRED CARE
NYP019008722OtherBLUE CHOICE
NYPA0309OtherPREFERRED CARE