Provider Demographics
NPI:1871630970
Name:MONTANARO, CHRISTOPHER (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:MONTANARO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:565 BRUNSWICK RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-9529
Mailing Address - Country:US
Mailing Address - Phone:530-274-7174
Mailing Address - Fax:530-274-7194
Practice Address - Street 1:565 BRUNSWICK RD
Practice Address - Street 2:SUITE #1
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-9529
Practice Address - Country:US
Practice Address - Phone:530-274-7174
Practice Address - Fax:530-274-7194
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A7304208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A73040Medicare ID - Type Unspecified