Healthcare Provider Details

I. General information

NPI: 1831306620
Provider Name (Legal Business Name): MARK C MONTEMARANO CRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 E ANDREW JOHNSON HWY
GREENEVILLE TN
37745-3098
US

IV. Provider business mailing address

425 SNYDER LN
GREENEVILLE TN
37743-7465
US

V. Phone/Fax

Practice location:
  • Phone: 423-787-6635
  • Fax:
Mailing address:
  • Phone: 423-620-5351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number217
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: