MEDICARE: MRS. SAMANTHA MASTERS MONTGOMERY MS, RD, LDN

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	133V00000X	Registered Dietitian	DN004761	PA

General Provider Information

NPI Number	:	1528338027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SAMANTHA MASTERS MONTGOMERY MS, RD, LDN

Provider Business Mailing Address
First Line	:	4007 WASHINGTON RD
Second Line	:
City	:	MC MURRAY
State	:	PA
Zip	:	15317-2520
Country	:	US
Telephone Number	:	724-941-7220
Fax Number	:

Provider Business Practice Location Address
First Line	:	4007 WASHINGTON RD
Second Line	:
City	:	MC MURRAY
State	:	PA
Zip	:	15317-2520
Country	:	US
Telephone Number	:	724-941-7220
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/31/2011
Last Update Date	:	04/09/2014

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