Provider Demographics
NPI:1104874155
Name:MONTANO, GARY L (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:L
Last Name:MONTANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GARY
Other - Middle Name:LYNN
Other - Last Name:MONTANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:271 CAREW ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-2377
Mailing Address - Country:US
Mailing Address - Phone:413-748-9137
Mailing Address - Fax:413-452-6049
Practice Address - Street 1:271 CAREW ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2377
Practice Address - Country:US
Practice Address - Phone:413-748-9137
Practice Address - Fax:413-452-6049
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81943207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA18462OtherHEALTH NEW ENGLAND
MA000000006791OtherBMC HEALTHNET
MA2485267OtherAETNA
MA3151395Medicaid
MA436513OtherHARVARD PILGRIM HEALTH PL
MA471123OtherCONNECTICARE
MAJ31993OtherBCBS OF MA
MA101634OtherCIGNA
MA755871OtherTUFTS HEALTHPLAN
MAJ31993OtherBCBS OF MA
MAA21199Medicare ID - Type Unspecified