Provider Demographics
NPI:1154407617
Name:MONTANTE, STEVEN J (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:MONTANTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5706 GROVE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2343
Mailing Address - Country:US
Mailing Address - Phone:804-325-4795
Mailing Address - Fax:804-441-8746
Practice Address - Street 1:5706 GROVE AVE STE 201
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226
Practice Address - Country:US
Practice Address - Phone:804-325-4795
Practice Address - Fax:804-441-8746
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101055334208200000X
OH35096601208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3115640Medicaid
VA010212057 541581185Medicaid
OH3115640Medicaid
VA010212057 541581185Medicaid
OH7423661Medicare PIN
VAVVC168AMedicare PIN