Basic Information
| Provider Information | |||||||||
| NPI: | 1275556854 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MONTELEONE | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 W. HIGH ST. | ||||||||
| Address2: | SUITE 214 | ||||||||
| City: | ELKTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109969490 | ||||||||
| FaxNumber: | 4109969493 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 W. HIGH ST. | ||||||||
| Address2: | SUITE 214 | ||||||||
| City: | ELKTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109969490 | ||||||||
| FaxNumber: | 4109969493 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 05/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | C10006525 | DE | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | C1-0006525 | DE | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | D0053675 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 277599 | 01 | MAMSI PROVIDER ID# | OTHER | 68563501 | 01 | MD | BLUE SHIELD PROV # | OTHER | 765703000 | 05 | MD | MEDICAID |