Healthcare Provider Details

I. General information

NPI: 1225133499
Provider Name (Legal Business Name): DERRICK ALAN MONTGOMERY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 UNIVERSITY BLVD E STE 11
SILVER SPRING MD
20903-2921
US

IV. Provider business mailing address

1060 W PERIMETER RD STE 3K43
JB ANDREWS MD
20762-6602
US

V. Phone/Fax

Practice location:
  • Phone: 301-431-0431
  • Fax: 301-431-0470
Mailing address:
  • Phone: 240-612-1730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License NumberD0098674
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD0098674
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number35.125039
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA96117
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number35.125039
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: