1265486898 NPI number — DANIE TEJADO MONTANO PA

Table of content: DANIE TEJADO MONTANO PA (NPI 1265486898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265486898 NPI number — DANIE TEJADO MONTANO PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONTANO
Provider First Name:
DANIE
Provider Middle Name:
TEJADO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265486898
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
USA MEDDAC WUERZBURG
Provider Second Line Business Mailing Address:
ATTN: CREDENTIALS OFFICE, UNIT 26610
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
01149931804
Provider Business Mailing Address Fax Number:
3241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
USA MEDDAC WUERZBURG
Provider Second Line Business Practice Location Address:
CONN CTMC
Provider Business Practice Location Address City Name:
APO AE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
09226-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
11-499-7219
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  NCCPA 1051879 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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