MEDICARE: MRS. EMILY KATHRYN MONTGOMERY-DEEM P.A.-C

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	363A00000X	Physician Assistant	01215	WV

General Provider Information

NPI Number	:	1720075369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EMILY KATHRYN MONTGOMERY-DEEM P.A.-C

Provider Business Mailing Address
First Line	:	2619 LARWOOD DR
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25302-4319
Country	:	US
Telephone Number	:	304-741-5984
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 LEE ST E STE 100
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25301-1864
Country	:	US
Telephone Number	:	304-388-1965
Fax Number	:

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

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	09/05/2024

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