Provider Demographics
NPI:1609985464
Name:MONTANE, BRENDA S (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:S
Last Name:MONTANE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6212
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:1717 S. ORANGE AVE.
Practice Address - Street 2:SUITE 100 NEMOURS CHILDRENS CLINIC
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2946
Practice Address - Country:US
Practice Address - Phone:407-650-7715
Practice Address - Fax:407-650-7124
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2011-09-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME445392080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048541100Medicaid
D77102Medicare UPIN
FLCS424ZMedicare PIN
96688XMedicare PIN