Individual
IVAN E MONTALVO-OTANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
830 WASHINGTON ST, WATERTOWN, NY 13601-4034
(315) 785-4313
(315) 779-5114
Mailing address
830 WASHINGTON ST, WATERTOWN, NY 13601-4034
(315) 785-4313
(315) 779-5114
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
218973
NY
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
218973
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02098319
—
NY
Enumeration date
06/21/2006
Last updated
04/17/2024
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