Provider Demographics
NPI:1194850594
Name:DEGUZMAN, BERNADETTE MONTANTE (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNADETTE
Middle Name:MONTANTE
Last Name:DEGUZMAN
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 W MCCREIGHT AVE
Mailing Address - Street 2:STE. 208
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-1842
Mailing Address - Country:US
Mailing Address - Phone:937-323-1187
Mailing Address - Fax:937-323-1456
Practice Address - Street 1:30 W MCCREIGHT AVE
Practice Address - Street 2:STE. 208
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-1842
Practice Address - Country:US
Practice Address - Phone:937-323-1187
Practice Address - Fax:937-323-1456
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35090125207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3034308Medicaid
OH3034308Medicaid
OH4286441Medicare PIN