Healthcare Provider Details

I. General information

NPI: 1457582835
Provider Name (Legal Business Name): MONTGOMERY ENDOSCOPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2009
Last Update Date: 08/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12012 VEIRS MILL RD
SILVER SPRING MD
20906-4513
US

IV. Provider business mailing address

12012 VEIRS MILL RD
SILVER SPRING MD
20906-4513
US

V. Phone/Fax

Practice location:
  • Phone: 301-942-3550
  • Fax: 301-933-3621
Mailing address:
  • Phone: 301-942-3550
  • Fax: 301-933-3621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA1024
License Number StateMD

VIII. Authorized Official

Name: DR. HOWARD GOLDBERG
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 301-942-3550