Healthcare Provider Details

I. General information

NPI: 1700221082
Provider Name (Legal Business Name): MICHAEL MONTELLO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 05/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 WATKINS MILL RD
GAITHERSBURG MD
20879-3301
US

IV. Provider business mailing address

7905 HOPE VALLEY CT
ADAMSTOWN MD
21710-9235
US

V. Phone/Fax

Practice location:
  • Phone: 240-632-4000
  • Fax:
Mailing address:
  • Phone: 301-798-2234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12260
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: