Provider Demographics
NPI:1689634545
Name:MONTO, RAYMOND ROCCO (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:ROCCO
Last Name:MONTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02554-2799
Mailing Address - Country:US
Mailing Address - Phone:508-825-8156
Mailing Address - Fax:508-825-8379
Practice Address - Street 1:57 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554-2799
Practice Address - Country:US
Practice Address - Phone:508-825-8156
Practice Address - Fax:508-825-8379
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA150697207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3150704Medicaid
MAJ31924OtherBLUE CROSS BLUE SHIELD
172446OtherHARVARD PILGRIM
MAF39589Medicare UPIN
MADX9384Medicare PIN