Provider Demographics
NPI:1649229683
Name:MONTERO, ALDEMAR (MD)
Entity Type:Individual
Prefix:
First Name:ALDEMAR
Middle Name:
Last Name:MONTERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:631 PROFESSIONAL DR STE 450
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-3370
Mailing Address - Country:US
Mailing Address - Phone:770-963-8030
Mailing Address - Fax:770-339-9577
Practice Address - Street 1:631 PROFESSIONAL DR STE 450
Practice Address - Street 2:SUITE 210
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3370
Practice Address - Country:US
Practice Address - Phone:770-963-8030
Practice Address - Fax:770-339-9577
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2010-07-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA57536207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI52289Medicare UPIN
GA4188940002Medicare NSC
GA4188640001Medicare NSC