MEDICARE: DR. MARY ANGELA MONTEMAYOR-RIVERA 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	207Q00000X	Family Medicine Physician	03572653	OH

General Provider Information

NPI Number	:	1831191006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY ANGELA MONTEMAYOR-RIVERA M.D.

Provider Business Mailing Address
First Line	:	103 LANDMARK DR STE 380
Second Line	:
City	:	BELLEVUE
State	:	KY
Zip	:	41073-1354
Country	:	US
Telephone Number	:	598-392-3970
Fax Number	:	598-392-3970

Provider Business Practice Location Address
First Line	:	4401 ROCKSIDE RD STE 214
Second Line	:
City	:	INDEPENDENCE
State	:	OH
Zip	:	44131-2147
Country	:	US
Telephone Number	:	513-878-0907
Fax Number	:	513-878-0908

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	08/22/2023

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