Basic Information
| Provider Information | |||||||||
| NPI: | 1558478305 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MONTMINY | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 848388 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022848388 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9044463451 | ||||||||
| FaxNumber: | 9044463013 | ||||||||
| Practice Location | |||||||||
| Address1: | 22 PINE ST | ||||||||
| Address2: | THE HOSPITAL OF CENTRAL CONNECTICUT-BRISOL FAMILY CENTE | ||||||||
| City: | BRISTOL | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060106948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605453112 | ||||||||
| FaxNumber: | 9044463013 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2006 | ||||||||
| LastUpdateDate: | 03/27/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0005X | 041878 | CT | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Undersea and Hyperbaric Medicine | 207Q00000X | 041878 | CT | N | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | 041878 | CT | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 001418789 | 05 | CT | MEDICAID |