Provider Demographics
NPI:1134225964
Name:HUNTLEY, MARIA (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:HUNTLEY
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 1:2525 E BROADWAY ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-8049
Mailing Address - Country:US
Mailing Address - Phone:406-457-4366
Mailing Address - Fax:406-457-4367
Practice Address - Street 1:2525 E BROADWAY ST
Practice Address - Street 2:SUITE 204
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-8049
Practice Address - Country:US
Practice Address - Phone:406-457-4366
Practice Address - Fax:406-457-4367
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8303207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0034595Medicaid
MTG63978Medicare UPIN
MT0034595Medicaid