1437104544 NPI number — MICHELLE MARIE MONTALBANO M.D.

Table of content: (NPI 1003686411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437104544 NPI number — MICHELLE MARIE MONTALBANO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONTALBANO
Provider First Name:
MICHELLE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MONTELBANO
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1437104544
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2430 NW MYHRE RD
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
SILVERDALE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98383-7669
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-337-1177
Provider Business Mailing Address Fax Number:
360-337-1170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2430 NW MYHRE RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SILVERDALE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98383-7669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-337-1177
Provider Business Practice Location Address Fax Number:
360-337-1170
Provider Enumeration Date:
05/24/2006

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: 207K00000X , with the licence number:  MD00045790 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: MD00045790 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7691645 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8454597 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1156MO . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 205756 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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