Healthcare Provider Details

I. General information

NPI: 1114929346
Provider Name (Legal Business Name): MANUEL MONTERO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 NEWMAN RD
NEW BERN NC
28562-5200
US

IV. Provider business mailing address

970 NEWMAN RD
NEW BERN NC
28562-5200
US

V. Phone/Fax

Practice location:
  • Phone: 252-633-9262
  • Fax: 252-317-2094
Mailing address:
  • Phone: 252-633-9262
  • Fax: 252-317-2094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number9800097
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier891109V
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 2
Identifier1109V
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerBCBS OF NC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: