Healthcare Provider Details

I. General information

NPI: 1508041393
Provider Name (Legal Business Name): MONTGOMERY RADIOLOGY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 12/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CRESSON BLVD SUITE 100
OAKS PA
19456
US

IV. Provider business mailing address

PO BOX 347279
PITTSBURGH PA
15251-4279
US

V. Phone/Fax

Practice location:
  • Phone: 610-650-0267
  • Fax: 610-650-0268
Mailing address:
  • Phone: 610-650-0267
  • Fax: 610-650-0268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN SOLOMON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 610-327-7571