Healthcare Provider Details

I. General information

NPI: 1083645220
Provider Name (Legal Business Name): MONTGOMERY INTERNAL MEDICINE ASSOC., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 04/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 OLNEY SANDY SPRING RD
OLNEY MD
20832-1521
US

IV. Provider business mailing address

2901 OLNEY SANDY SPRING RD
OLNEY MD
20832-1521
US

V. Phone/Fax

Practice location:
  • Phone: 301-774-6655
  • Fax: 301-774-5652
Mailing address:
  • Phone: 301-774-6655
  • Fax: 301-774-5652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHAN MALTZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 301-774-6655