Healthcare Provider Details

I. General information

NPI: 1376509604
Provider Name (Legal Business Name): PATRICIA A MONTAPERTO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 05/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 BILLERICA RD INTERNAL MEDICINE
CHELMSFORD MA
01824-3604
US

IV. Provider business mailing address

147 MILK ST PROVIDER ENROLLMENT - 9TH FLOOR
BOSTON MA
02109-4806
US

V. Phone/Fax

Practice location:
  • Phone: 978-250-6100
  • Fax: 978-250-6471
Mailing address:
  • Phone: 617-559-8374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number50694
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: