Healthcare Provider Details

I. General information

NPI: 1114922341
Provider Name (Legal Business Name): MONTGOMERY GENERAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18101 PRINCE PHILIP DR
OLNEY MD
20832-1514
US

IV. Provider business mailing address

18101 PRINCE PHILIP DR
OLNEY MD
20832-1514
US

V. Phone/Fax

Practice location:
  • Phone: 301-774-8649
  • Fax: 301-774-9676
Mailing address:
  • Phone:
  • Fax: 301-774-9676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number15-202
License Number StateMD

VIII. Authorized Official

Name: MR. JOHN HOGARTY
Title or Position: SR. VICE PRESIDENT/ CFO
Credential:
Phone: 301-774-8649