Individual
DR. CARLOS E MONTENEGRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
408 JACKSON AVE E, HAMPTON, SC 29924
(803) 943-4003
(803) 943-4701
Mailing address
PO BOX 1289, VARNVILLE, SC 29944
(803) 943-4003
(803) 943-4701
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
23479
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
234797
—
SC
01
—
P00166936
RAILROAD MEDICARE
SC
Enumeration date
05/09/2006
Last updated
11/07/2008
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