Provider Demographics
NPI:1255446399
Name:MONTALDI, STEPHEN HOWARD (DO)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:HOWARD
Last Name:MONTALDI
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:PO BOX 530
Mailing Address - Street 2:1007 N 16TH ST
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-4319
Mailing Address - Country:US
Mailing Address - Phone:765-529-0780
Mailing Address - Fax:765-529-3554
Practice Address - Street 1:1007 N 16TH ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-4319
Practice Address - Country:US
Practice Address - Phone:765-529-0780
Practice Address - Fax:765-529-3554
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7171207RS0010X
IN002003452207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200926520Medicaid
IN200926520Medicaid