Healthcare Provider Details

I. General information

NPI: 1861847626
Provider Name (Legal Business Name): CAROLINA MARIA MONTANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4319
US

IV. Provider business mailing address

2929 ARCH ST FL 12
PHILADELPHIA PA
19104-2857
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-2920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number130463
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number2023154
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: