Provider Demographics
NPI:1831191006
Name:MONTEMAYOR-RIVERA, MARY ANGELA (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANGELA
Last Name:MONTEMAYOR-RIVERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:103 LANDMARK DR STE 380
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:KY
Mailing Address - Zip Code:41073-1354
Mailing Address - Country:US
Mailing Address - Phone:598-392-3970
Mailing Address - Fax:598-392-3970
Practice Address - Street 1:4401 ROCKSIDE RD STE 214
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2147
Practice Address - Country:US
Practice Address - Phone:513-878-0907
Practice Address - Fax:513-878-0908
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH03572653207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2073018Medicaid
OHG58226Medicare UPIN
OHMO0830264Medicare PIN