| Organization Name: | MARTHA'S VINEYARD ORTHOPEDIC SURGERY AND SPORTS MEDICINE |
| NPI Number: | 1588624415 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RAYMOND ROCCO MONTO (CEO) |
| Mailing Address: | 12 Cournoyer Road West Tisbury |
| State: | MA US |
| Postal Code: | 025750547 |
| Phone Number: | 5086935949 |
| Fax Number: | 5086930319 |
| NPI Enumeration Date: | 03/24/2006 |
| NPI Last Update Date: | 11/25/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |