Healthcare Provider Details

I. General information

NPI: 1902852536
Provider Name (Legal Business Name): KATHRYN LOUISE PONTO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 CANNON ST
HELENA MT
59601-2099
US

IV. Provider business mailing address

4202 EDGEWATER WAY
STEVENSVILLE MT
59870-6466
US

V. Phone/Fax

Practice location:
  • Phone: 406-422-1236
  • Fax:
Mailing address:
  • Phone: 206-669-0925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD00025961
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMED-PHYS-LIC-103374
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: