Provider Demographics
NPI:1699946640
Name:MONTELLA, KAREN T (PA)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:T
Last Name:MONTELLA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 242
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-0242
Mailing Address - Country:US
Mailing Address - Phone:516-576-6106
Mailing Address - Fax:516-576-5801
Practice Address - Street 1:10344 OLD OCEAN CITY BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1162
Practice Address - Country:US
Practice Address - Phone:410-641-2938
Practice Address - Fax:410-641-4904
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008610363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant