Individual provider Active NPI

Lisandro Miguel Montorfano, M.D

  • Plastic Surgery Physician
  • Greensboro, NC
National Provider Identifier
1174970198
Registry record updated Jun 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
2024-03284 Issued in NC
Practice address
1002 N Church St Ste 100
Greensboro, NC 27401-1447
Phone
(336) 890-2210
NPI assigned
May 19, 2016
Last updated
Jun 24, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X 2024-03284 NC Primary
Surgery Physician 208600000X TRN# 19647 FL

Addresses

Primary practice location

1002 N Church St Ste 100
Greensboro, NC 27401-1447

Mailing address

110 19TH Ave S Apt 1618TH
Nashville, TN 37203-2717
Phone (843) 442-9845

Other identifiers 1

IdentifierTypeStateIssuer
158504375OtherTNDRIVERS LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250703003590 NC Practitioner - Plastic and Reconstructive SurgeryPractitioner - General Surgery 7214296714 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive SurgeryAlso: General Surgery
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1002 N Church St
Suite 100
Greensboro, NC 27401-1447
Phone (336) 890-2210

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy1-10
Melanoma (skin cancer) excision1-10
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
TRN# 19647FLMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Moses Cone Physician Services, Inc. Surgery Current Accepting new patients
Moses Cone Physician Services Inc CurrentSince Jul 28, 2025 Accepting new patients
Moses Cone Physician Services, Inc. Plastic Surgery CurrentSince Jul 28, 2025 Accepting new patients
Moses Cone Physician Services, Inc. Surgery Past Accepting new patients

Locations

1002 N Church St
Ste 100
Greensboro, NC 27401
Phone (336) 275-6600

1200 N Elm St
Greensboro, NC 27401
Phone (336) 574-7000

300 E Wendover Ave
Fl 2
Greensboro, NC 27401
Phone (336) 663-5219

301 E Wendover Ave
Ste 411
Greensboro, NC 27401
Phone (336) 832-3200

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1463616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750723200000",
    "number": "1174970198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 19TH AVE S APT 1618TH",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372032717",
            "telephone_number": "843-442-9845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 N CHURCH ST STE 100",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274011447",
            "telephone_number": "336-890-2210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTORFANO",
        "first_name": "LISANDRO",
        "middle_name": "MIGUEL",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-19",
        "last_updated": "2025-06-24",
        "certification_date": "2025-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "NC",
            "license": "2024-03284",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "TRN# 19647",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVERS LICENSE",
            "identifier": "158504375",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greensboro, NC

Sources for this page

Verify at the official NPI Registry.