MEDICARE: MONTGOMERY OTOLARYNGOLOGY CONSULTANTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician

General Provider Information

NPI Number	:	1073507117
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTGOMERY OTOLARYNGOLOGY CONSULTANTS

Provider Business Mailing Address
First Line	:	19211 MONTGOMERY VILLAGE AVE
Second Line	:	#B-23
City	:	GAITHERSBURG
State	:	MD
Zip	:	20886-5028
Country	:	US
Telephone Number	:	301-963-6334
Fax Number	:	301-869-7204

Provider Business Practice Location Address
First Line	:	19211 MONTGOMERY VILLAGE AVE
Second Line	:	#B-23
City	:	GAITHERSBURG
State	:	MD
Zip	:	20886-5028
Country	:	US
Telephone Number	:	301-963-6334
Fax Number	:	301-869-7204

Authorized Official
Title or Position	:	ENT PHYSICIAN
Name	:	LINDSAY IRA GOLDEN
Credential	:	MD
Telephone Number	:	301-963-6334

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	08/06/2010

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