Provider Demographics
NPI:1710971023
Name:RECOBER- MONTILLA, ANA (MD)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:RECOBER- MONTILLA
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 1:100 E LANCASTER AVE LMC BLDG EAST, SUITE 256
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096
Mailing Address - Country:US
Mailing Address - Phone:484-572-6300
Mailing Address - Fax:484-572-6305
Practice Address - Street 1:100 E LANCASTER AVE LMC BLDG EAST, SUITE 256
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096
Practice Address - Country:US
Practice Address - Phone:484-572-6300
Practice Address - Fax:484-572-6305
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA358702084N0400X
PAMD4531752084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA38130OtherWELLMARK BCBS
IA0455279Medicaid
IA38130OtherWELLMARK BCBS
IAP00265512Medicare PIN
IA0455279Medicaid