Healthcare Provider Details

I. General information

NPI: 1881036903
Provider Name (Legal Business Name): RICHARD V. MONTILLA M.D, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2013
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 SUMMER ST STE 675
WORCESTER MA
01608-1216
US

IV. Provider business mailing address

299 LINCOLN ST STE 201
WORCESTER MA
01605-3646
US

V. Phone/Fax

Practice location:
  • Phone: 508-948-4030
  • Fax:
Mailing address:
  • Phone: 508-852-2001
  • Fax: 508-852-3001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. BERNADETTE MONTILLA
Title or Position: PRACTICE MANAGER
Credential:
Phone: 508-948-4030