Provider Demographics
NPI:1356354005
Name:VANBEBER, MONTY JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:MONTY
Middle Name:JAMES
Last Name:VANBEBER
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 1:86 HOLLY HILL RD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02632-3337
Mailing Address - Country:US
Mailing Address - Phone:508-827-7065
Mailing Address - Fax:
Practice Address - Street 1:233 STEVENS ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3766
Practice Address - Country:US
Practice Address - Phone:508-771-3190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD430421207Q00000X
CT045062207Q00000X
MA235643207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA111105GNQMedicare PIN
PAI73791Medicare UPIN