Healthcare Provider Details

I. General information

NPI: 1427553171
Provider Name (Legal Business Name): EMIL WOLDEN HJORTH MONTANO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 EXECUTIVE DR STE H
DANVILLE VA
24541
US

IV. Provider business mailing address

125 EXECUTIVE DR STE H
DANVILLE VA
24541-4155
US

V. Phone/Fax

Practice location:
  • Phone: 434-791-1345
  • Fax: 434-773-6811
Mailing address:
  • Phone: 434-379-1134
  • Fax: 434-773-6811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberVA0116031723
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: