Healthcare Provider Details

I. General information

NPI: 1699946640
Provider Name (Legal Business Name): KAREN T MONTELLA P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 09/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10344 OLD OCEAN CITY BLVD SUITE 1
BERLIN MD
21811-1162
US

IV. Provider business mailing address

PO BOX 242
BERLIN MD
21811-0242
US

V. Phone/Fax

Practice location:
  • Phone: 410-641-2938
  • Fax: 410-641-4904
Mailing address:
  • Phone: 516-576-6106
  • Fax: 516-576-5801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number008610
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: