Provider Demographics
NPI:1407958101
Name:MONTALTO, NORMAN J (DO)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:J
Last Name:MONTALTO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 GREAT TEAYS BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-9816
Mailing Address - Country:US
Mailing Address - Phone:304-757-6999
Mailing Address - Fax:304-757-3252
Practice Address - Street 1:116 HILLS PLZ
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25387-2438
Practice Address - Country:US
Practice Address - Phone:304-720-4466
Practice Address - Fax:304-720-4821
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1481207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0054307000Medicaid
WVWV0132BMedicare PIN
WV2031662Medicare PIN
WV2031663Medicare PIN
WV2031661Medicare PIN
WVMO0644759Medicare ID - Type Unspecified
WVWV0132AMedicare PIN
E29824Medicare UPIN