MEDICARE: DR. MIGDONIA MONTEJO 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	174400000X	Specialist	0101058505	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	119124	OTHER	VA	ANTHEM BC/BS
2	7852026	OTHER		AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	19462	OTHER	VA	SENTARA OPTIMA
5	370927	OTHER		MDIPA/MAMSI/OPTIMUM
6	603296	OTHER	PA	BC/BS PENNSYLVANIA
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467459347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIGDONIA MONTEJO M.D.

Provider Business Mailing Address
First Line	:	110 KINGSLEY LN
Second Line	:	SUITE 106
City	:	NORFOLK
State	:	VA
Zip	:	23505-4614
Country	:	US
Telephone Number	:	757-889-5735
Fax Number	:	757-889-5742

Provider Business Practice Location Address
First Line	:	110 KINGSLEY LN
Second Line	:	SUITE 106
City	:	NORFOLK
State	:	VA
Zip	:	23505-4614
Country	:	US
Telephone Number	:	757-889-5735
Fax Number	:	757-889-5742

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	12/18/2007

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Directions to “ DR. MIGDONIA MONTEJO M.D.” Practice Location

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