Healthcare Provider Details

I. General information

NPI: 1750403499
Provider Name (Legal Business Name): MATTHEW MORRISON MONTGOMERY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 HIGHLAND AVE
CINCINNATI OH
45219-2399
US

IV. Provider business mailing address

3130 HIGHLAND AVE
CINCINNATI OH
45219-2399
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-1339
  • Fax:
Mailing address:
  • Phone: 513-558-1339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License NumberME100567
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number123488
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: