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  7. NPI Record 1043294564

DR. MARY JO MONTANARELLA M.D
Complete NPI Record 1043294564
Obstetrics & Gynecology in Manchester, NH


Quality Rating: 30 out of 100 score

NPI Status: Active since November 30, 2005

Contact Information

30 CANTON ST
SUITE 6
MANCHESTER, NH
ZIP 03103
Phone: (603) 624-1638
Fax: (603) 624-1972

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider Name Prefix Text
  6. Provider Credential Text
  7. Provider First Line Business Mailing Address
  8. Provider Second Line Business Mailing Address
  9. Provider Business Mailing Address City Name
  10. Provider Business Mailing Address State Name
  11. Provider Business Mailing Address Postal Code
  12. Provider Business Mailing Address Country Code If outside U S
  13. Provider Business Mailing Address Telephone Number
  14. Provider Business Mailing Address Fax Number
  15. Provider First Line Business Practice Location Address
  16. Provider Second Line Business Practice Location Address
  17. Provider Business Practice Location Address City Name
  18. Provider Business Practice Location Address State Name
  19. Provider Business Practice Location Address Postal Code
  20. Provider Business Practice Location Address Country Code If outside U S
  21. Provider Business Practice Location Address Telephone Number
  22. Provider Business Practice Location Address Fax Number
  23. Provider Enumeration Date
  24. Last Update Date
  25. Provider Gender Code
  26. Healthcare Provider Taxonomy Code 1
  27. Provider License Number 1
  28. Provider License Number State Code 1
  29. Healthcare Provider Primary Taxonomy Switch 1
  30. Healthcare Provider Taxonomy Code 2
  31. Provider License Number 2
  32. Provider License Number State Code 2
  33. Healthcare Provider Primary Taxonomy Switch 2
  34. Healthcare Provider Taxonomy Code 3
  35. Provider License Number 3
  36. Provider License Number State Code 3
  37. Healthcare Provider Primary Taxonomy Switch 3
  38. Other Provider Identifier 1
  39. Other Provider Identifier Type Code 1
  40. Other Provider Identifier State 1
  41. Other Provider Identifier Issuer 1
  42. Other Provider Identifier 2
  43. Other Provider Identifier Type Code 2
  44. Other Provider Identifier State 2
  45. Other Provider Identifier Issuer 2
  46. Other Provider Identifier 3
  47. Other Provider Identifier Type Code 3
  48. Other Provider Identifier State 3
  49. Other Provider Identifier Issuer 3
  50. Other Provider Identifier 4
  51. Other Provider Identifier Type Code 4
  52. Other Provider Identifier State 4
  53. Other Provider Identifier Issuer 4
  54. Other Provider Identifier 5
  55. Other Provider Identifier Type Code 5
  56. Other Provider Identifier State 5
  57. Other Provider Identifier Issuer 5
  58. Other Provider Identifier 6
  59. Other Provider Identifier Type Code 6
  60. Other Provider Identifier State 6
  61. Other Provider Identifier Issuer 6
  62. Other Provider Identifier 7
  63. Other Provider Identifier Type Code 7
  64. Other Provider Identifier State 7
  65. Other Provider Identifier Issuer 7
  66. Other Provider Identifier 8
  67. Other Provider Identifier Type Code 8
  68. Other Provider Identifier State 8
  69. Other Provider Identifier 9
  70. Other Provider Identifier Type Code 9
  71. Other Provider Identifier State 9
  72. Other Provider Identifier Issuer 9
  73. Other Provider Identifier 10
  74. Other Provider Identifier Type Code 10
  75. Other Provider Identifier State 10
  76. Other Provider Identifier Issuer 10
  77. Other Provider Identifier 11
  78. Other Provider Identifier Type Code 11
  79. Other Provider Identifier Issuer 11
  80. Other Provider Identifier 12
  81. Other Provider Identifier Type Code 12
  82. Other Provider Identifier State 12
  83. Other Provider Identifier Issuer 12
  84. Other Provider Identifier 13
  85. Other Provider Identifier Type Code 13
  86. Other Provider Identifier State 13
  87. Other Provider Identifier Issuer 13
  88. Other Provider Identifier 14
  89. Other Provider Identifier Type Code 14
  90. Other Provider Identifier State 14
  91. Other Provider Identifier Issuer 14
  92. Other Provider Identifier 15
  93. Other Provider Identifier Type Code 15
  94. Other Provider Identifier State 15
  95. Other Provider Identifier Issuer 15
  96. Is Sole Proprietor

Complete NPI Dataset

This page represents the complete record for NPI 1043294564. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1043294564
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 1
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
The last name of the provider. If the provider is an individual, this is the legal name.
Provider First Name: MARY JO
The first name of the provider, if the provider is an individual.
Provider Name Prefix Text: DR.
The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
Provider Credential Text: M.D
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider First Line Business Mailing Address: 30 CANTON ST
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Second Line Business Mailing Address: SUITE 6
The second line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider second line location address’’.
Provider Business Mailing Address City Name: MANCHESTER
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: NH
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 031033524
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 6036241638
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 6036241972
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 30 CANTON ST
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location Address: SUITE 6
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: MANCHESTER
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: NH
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 031033524
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 6036241638
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 6036241972
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 11/30/2005
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 10/1/2013
The date that a record was last updated or changed.
Provider Gender Code: F
The code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 1: 207V00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: 8358
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: NH
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: Y
Healthcare Provider Taxonomy Code 2: 207VG0400X
Provider License Number 2: 8358
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 2: NH
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 2: N
Healthcare Provider Taxonomy Code 3: 207VX0000X
Provider License Number 3: 8358
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 3: NH
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 3: N
Other Provider Identifier 1: 2755
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: NH
Other Provider Identifier Issuer 1: HEALTHSOURCE
Other Provider Identifier 2: NX1984
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2: NH
Other Provider Identifier Issuer 2: PTAN
Other Provider Identifier 3: 759308
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 3: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 3: NH
Other Provider Identifier Issuer 3: TUFTS
Other Provider Identifier 4: 0105135Y0NH01
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 4: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 4: NH
Other Provider Identifier Issuer 4: ANTHEM
Other Provider Identifier 5: 141852219
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 5: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 5: NH
Other Provider Identifier Issuer 5: UNITED HEALTHCARE
Other Provider Identifier 6: 2950237
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 6: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 6: NH
Other Provider Identifier Issuer 6: HMO(QUALITY POS, US ACCES
Other Provider Identifier 7: 141852219
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 7: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 7: NH
Other Provider Identifier Issuer 7: HCVM
Other Provider Identifier 8: 3072647
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 8: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 8: NH
Other Provider Identifier 9: E55310
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 9: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 9: NH
Other Provider Identifier Issuer 9: HARVARD PILGRIM
Other Provider Identifier 10: 141852219
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 10: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 10: NH
Other Provider Identifier Issuer 10: UNICARE
Other Provider Identifier 11: 0702141
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 11: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 11: DIRECT ACCESS
Other Provider Identifier 12: 141852219
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 12: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 12: NH
Other Provider Identifier Issuer 12: CIGNA
Other Provider Identifier 13: 141852219
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 13: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 13: NH
Other Provider Identifier Issuer 13: PHCS
Other Provider Identifier 14: 165135
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 14: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 14: NH
Other Provider Identifier Issuer 14: BLUE CHOICE/HMO BLUE/INDE
Other Provider Identifier 15: 141852219
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 15: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 15: NH
Other Provider Identifier Issuer 15: ONE HEALTH PLAN
Is Sole Proprietor: Y
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No