Healthcare Provider Details

I. General information

NPI: 1043294564
Provider Name (Legal Business Name): MARY JO MONTANARELLA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 10/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 CANTON ST SUITE 6
MANCHESTER NH
03103-3524
US

IV. Provider business mailing address

30 CANTON ST SUITE 6
MANCHESTER NH
03103-3524
US

V. Phone/Fax

Practice location:
  • Phone: 603-624-1638
  • Fax: 603-624-1972
Mailing address:
  • Phone: 603-624-1638
  • Fax: 603-624-1972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number8358
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number8358
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number8358
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: