Provider Demographics
NPI:1518962711
Name:MONTZ, NANCY COLETTE (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:COLETTE
Last Name:MONTZ
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:PO BOX 601488
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1488
Mailing Address - Country:US
Mailing Address - Phone:704-548-8724
Mailing Address - Fax:704-548-0927
Practice Address - Street 1:101 E WT HARRIS BLVD
Practice Address - Street 2:SUITE 5002
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3485
Practice Address - Country:US
Practice Address - Phone:704-548-8724
Practice Address - Fax:704-548-0927
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200401279174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900328Medicaid
NC5900328Medicaid
NCI25450Medicare UPIN