Provider Demographics
NPI:1386605111
Name:MONTEIRO, ILDEFONSO C (MD)
Entity type:Individual
Prefix:DR
First Name:ILDEFONSO
Middle Name:C
Last Name:MONTEIRO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 740209
Mailing Address - Street 2:DEPT 1041
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-0209
Mailing Address - Country:US
Mailing Address - Phone:941-360-1566
Mailing Address - Fax:941-358-9818
Practice Address - Street 1:2621 GROVE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4300
Practice Address - Country:US
Practice Address - Phone:804-254-5100
Practice Address - Fax:804-254-5187
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2009-05-05
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Provider Licenses
StateLicense IDTaxonomies
VA010122334207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B09638Medicare UPIN
VA00X968C04Medicare PIN