Healthcare Provider Details

I. General information

NPI: 1821416850
Provider Name (Legal Business Name): UWA IBELEMA MONTGOMERY M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 LINDEN AVE
BALTIMORE MD
21201-4622
US

IV. Provider business mailing address

800 LINDEN AVE
BALTIMORE MD
21201-4622
US

V. Phone/Fax

Practice location:
  • Phone: 410-856-3660
  • Fax: 410-225-8992
Mailing address:
  • Phone: 410-856-3660
  • Fax: 410-225-8992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0094331
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0094331
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: