MEDICARE: DR. MARY JO MONTANARELLA M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	8358	NH
2	207VG0400X	Gynecology Physician	8358	NH
3	207VX0000X	Obstetrics Physician	8358	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	165135	OTHER	NH	BLUE CHOICE/HMO BLUE/INDE
2	2950237	OTHER	NH	HMO(QUALITY POS, US ACCES
3	0702141	OTHER		DIRECT ACCESS
4	141852219	OTHER	NH	UNITED HEALTHCARE
5	2755	OTHER	NH	HEALTHSOURCE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	141852219	OTHER	NH	CIGNA
8	0105135Y0NH01	OTHER	NH	ANTHEM
9	141852219	OTHER	NH	HCVM
10	759308	OTHER	NH	TUFTS
11	E55310	OTHER	NH	HARVARD PILGRIM
12	NX1984	OTHER	NH	PTAN
13	141852219	OTHER	NH	UNICARE
14	141852219	OTHER	NH	ONE HEALTH PLAN
15	141852219	OTHER	NH	PHCS

General Provider Information

NPI Number	:	1043294564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY JO MONTANARELLA M.D

Provider Business Mailing Address
First Line	:	30 CANTON ST
Second Line	:	SUITE 6
City	:	MANCHESTER
State	:	NH
Zip	:	03103-3524
Country	:	US
Telephone Number	:	603-624-1638
Fax Number	:	603-624-1972

Provider Business Practice Location Address
First Line	:	30 CANTON ST
Second Line	:	SUITE 6
City	:	MANCHESTER
State	:	NH
Zip	:	03103-3524
Country	:	US
Telephone Number	:	603-624-1638
Fax Number	:	603-624-1972

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	10/01/2013

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