Healthcare Provider Details

I. General information

NPI: 1700175965
Provider Name (Legal Business Name): CHRISTOPHER GEORGE MONTGOMERY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 07/06/2023
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 CANAL VIEW BLVD SUITE 102
ROCHESTER NY
14623
US

IV. Provider business mailing address

140 CANAL VIEW BLVD SUITE 102
ROCHESTER NY
14623
US

V. Phone/Fax

Practice location:
  • Phone: 585-338-2700
  • Fax: 585-242-9663
Mailing address:
  • Phone: 585-338-2700
  • Fax: 585-242-9663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number271440
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number271440
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: