MEDICARE: MARK LETTERIO MONTEFERRANTE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	D0044877	MD
2	2085R0202X	Diagnostic Radiology Physician	185036	NY
3	2085R0202X	Diagnostic Radiology Physician	MD20122	DC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	470001526	OTHER		RR MEDICARE
2	300135377	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780665851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK LETTERIO MONTEFERRANTE M.D.

Provider Business Mailing Address
First Line	:	3201 JERMANTOWN RD STE 550
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22030-2885
Country	:	US
Telephone Number	:	703-667-8600
Fax Number	:	703-667-8601

Provider Business Practice Location Address
First Line	:	3301 NEW MEXICO AVE NW
Second Line	:	SUITE 106
City	:	WASHINGTON
State	:	DC
Zip	:	20016-3622
Country	:	US
Telephone Number	:	202-966-0606
Fax Number	:	202-244-6757

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	06/21/2021

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Directions to “ MARK LETTERIO MONTEFERRANTE M.D.” Practice Location

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