Healthcare Provider Details

I. General information

NPI: 1619816642
Provider Name (Legal Business Name): MONTGOMERY BRAIN AND SPINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 HARRY S TRUMAN DR N STE 2
LARGO MD
20774-5477
US

IV. Provider business mailing address

1300 SPRING ST STE 210
SILVER SPRING MD
20910-3654
US

V. Phone/Fax

Practice location:
  • Phone: 301-585-7900
  • Fax:
Mailing address:
  • Phone: 301-585-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: APRIL POWELL
Title or Position: CREDENTIALING
Credential:
Phone: 814-826-0500