Provider Demographics
NPI:1932208659
Name:MONTILLA, MYRNA CUETO (MD)
Entity Type:Individual
Prefix:
First Name:MYRNA
Middle Name:CUETO
Last Name:MONTILLA
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 1:6217 HARFORD ROAD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214
Mailing Address - Country:US
Mailing Address - Phone:410-444-5245
Mailing Address - Fax:410-426-3172
Practice Address - Street 1:6217 HARFORD ROAD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214
Practice Address - Country:US
Practice Address - Phone:410-444-5245
Practice Address - Fax:410-426-3172
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD18929208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
C57752Medicare UPIN