Provider Demographics
NPI:1700080116
Name:CATALANELLO, MARK JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JAY
Last Name:CATALANELLO
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 1:11 PARADOX LANE
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:MT
Mailing Address - Zip Code:59859
Mailing Address - Country:US
Mailing Address - Phone:406-826-5064
Mailing Address - Fax:406-826-1283
Practice Address - Street 1:11 PARADOX LN
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:MT
Practice Address - Zip Code:59859-9367
Practice Address - Country:US
Practice Address - Phone:406-826-5064
Practice Address - Fax:406-826-1283
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7315207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT7315OtherMONTANA MEDICAL LICENSE
MT7315OtherMONTANA MEDICAL LICENSE