Provider Demographics
NPI:1780665851
Name:MONTEFERRANTE, MARK LETTERIO (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:LETTERIO
Last Name:MONTEFERRANTE
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 1:3201 JERMANTOWN RD STE 550
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2885
Mailing Address - Country:US
Mailing Address - Phone:703-667-8600
Mailing Address - Fax:703-667-8601
Practice Address - Street 1:3301 NEW MEXICO AVE NW
Practice Address - Street 2:SUITE 106
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-3622
Practice Address - Country:US
Practice Address - Phone:202-966-0606
Practice Address - Fax:202-244-6757
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00448772085R0202X
NY1850362085R0202X
DCMD201222085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
470001526OtherRR MEDICARE
300135377OtherRR MEDICARE
MD161631501Medicaid
DC00B428O31Medicare PIN
470001526OtherRR MEDICARE
MD161631501Medicaid
300135377OtherRR MEDICARE
DC010139W30Medicare PIN
MDFMX003Medicare PIN