Healthcare Provider Details

I. General information

NPI: 1629234547
Provider Name (Legal Business Name): SEAN PAUL MONTGOMERY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WALTER REED AMC 6900 GEORGIA AVENUE, NW, 5TH FLOOR
WASHINGTON DC
20307-0001
US

IV. Provider business mailing address

WALTER REED AMC 6900 GEORGIA AVENUE, NW, 5TH FLOOR
WASHINGTON DC
20307-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-782-9690
  • Fax:
Mailing address:
  • Phone: 202-782-9690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number057896
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number057896
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: