Provider Demographics
NPI:1689668600
Name:MONTANARO, JOSEPH JR (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:MONTANARO
Suffix:JR
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 1:611 E FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:OLIVIA
Mailing Address - State:MN
Mailing Address - Zip Code:56277-4213
Mailing Address - Country:US
Mailing Address - Phone:320-523-1460
Mailing Address - Fax:320-523-8349
Practice Address - Street 1:600 E PARK AVE
Practice Address - Street 2:
Practice Address - City:OLIVIA
Practice Address - State:MN
Practice Address - Zip Code:56277-1370
Practice Address - Country:US
Practice Address - Phone:320-523-1460
Practice Address - Fax:320-523-8349
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9193207V00000X
OH35120235207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80003141Medicaid
NHRE3141Medicare PIN
NH80003141Medicaid