Provider Demographics
NPI:1467459347
Name:MONTEJO, MIGDONIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGDONIA
Middle Name:
Last Name:MONTEJO
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 1:110 KINGSLEY LN
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-4614
Mailing Address - Country:US
Mailing Address - Phone:757-889-5735
Mailing Address - Fax:757-889-5742
Practice Address - Street 1:110 KINGSLEY LN
Practice Address - Street 2:SUITE 106
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-4614
Practice Address - Country:US
Practice Address - Phone:757-889-5735
Practice Address - Fax:757-889-5742
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058505174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA119124OtherANTHEM BC/BS
7852026OtherAETNA
VA5602076Medicaid
VA19462OtherSENTARA OPTIMA
370927OtherMDIPA/MAMSI/OPTIMUM
PA603296OtherBC/BS PENNSYLVANIA
NC89064GWMedicaid
VA19462OtherSENTARA OPTIMA