MEDICARE: DR. MARK ROBERT MONTONEY 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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	049150	OH

General Provider Information

NPI Number	:	1801942867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ROBERT MONTONEY M.D.

Provider Business Mailing Address
First Line	:	180 E BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43215-3707
Country	:	US
Telephone Number	:	614-544-4404
Fax Number	:	614-544-4450

Provider Business Practice Location Address
First Line	:	180 E BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43215-3707
Country	:	US
Telephone Number	:	614-544-4404
Fax Number	:	614-544-4450

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

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	07/08/2007

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