Provider Demographics
NPI:1275556854
Name:MONTELEONE, ROBERT ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ANTHONY
Last Name:MONTELEONE
Suffix:
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 1:111 W. HIGH ST.
Mailing Address - Street 2:SUITE 214
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921
Mailing Address - Country:US
Mailing Address - Phone:410-996-9490
Mailing Address - Fax:410-996-9493
Practice Address - Street 1:111 W. HIGH ST.
Practice Address - Street 2:SUITE 214
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921
Practice Address - Country:US
Practice Address - Phone:410-996-9490
Practice Address - Fax:410-996-9493
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10006525207Q00000X
DEC1-0006525207Q00000X
MDD0053675207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
277599OtherMAMSI PROVIDER ID#
MD68563501OtherBLUE SHIELD PROV #
MD765703000Medicaid
277599OtherMAMSI PROVIDER ID#
238MMedicare ID - Type Unspecified
MD765703000Medicaid