Provider Demographics
NPI:1174635965
Name:LAMONTAGNE, KRISTIN E (MD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:E
Last Name:LAMONTAGNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:197 ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01267-2930
Mailing Address - Country:US
Mailing Address - Phone:413-458-8182
Mailing Address - Fax:413-458-3140
Practice Address - Street 1:71 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247-2504
Practice Address - Country:US
Practice Address - Phone:413-664-5710
Practice Address - Fax:413-664-5773
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA246971207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110088727AMedicaid
VT1019456Medicaid