Healthcare Provider Details

I. General information

NPI: 1033112966
Provider Name (Legal Business Name): JUDITH MONTEFERRANTE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 EASTERN POINT RD
GLOUCESTER MA
01930-4139
US

IV. Provider business mailing address

45 EASTERN POINT RD
GLOUCESTER MA
01930-4139
US

V. Phone/Fax

Practice location:
  • Phone: 978-283-6856
  • Fax: 978-282-0977
Mailing address:
  • Phone: 978-283-6856
  • Fax: 978-282-0977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number138569
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: