Provider Demographics
NPI:1255494019
Name:MONTANARO, DAVID (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MONTANARO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 MILLER SPRINGS CT, ATTN CBO
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-5434
Mailing Address - Country:US
Mailing Address - Phone:740-775-6119
Mailing Address - Fax:740-775-6999
Practice Address - Street 1:311 CALDWELL ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-3332
Practice Address - Country:US
Practice Address - Phone:740-775-6119
Practice Address - Fax:740-775-6999
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-4535207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000346137OtherPROVIDER BCBS NUMBER
OHE38776Medicare UPIN
OH0653253Medicare ID - Type UnspecifiedPROVIDER MEDICARE NUMBER