MEDICARE: MAURICIO DANIEL CARBALLO MONTERO MD

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	207RG0100X	Gastroenterology Physician	35.138586	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508173568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAURICIO DANIEL CARBALLO MONTERO MD

Provider Business Mailing Address
First Line	:	10863 MARIAM LN
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45458-6412
Country	:	US
Telephone Number	:	937-545-1539
Fax Number	:

Provider Business Practice Location Address
First Line	:	10863 MARIAM LN
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45458-6412
Country	:	US
Telephone Number	:	937-545-1539
Fax Number	:

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

Provider Enumeration Date	:	09/10/2010
Last Update Date	:	03/05/2026

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