Healthcare Provider Details

I. General information

NPI: 1255328076
Provider Name (Legal Business Name): BEN E MONTGOMERY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 S QUEEN ST SUITE 200
YORK PA
17403-4829
US

IV. Provider business mailing address

601 MEMORY LN
YORK PA
17402-2231
US

V. Phone/Fax

Practice location:
  • Phone: 717-812-2316
  • Fax: 717-848-5540
Mailing address:
  • Phone: 717-851-1405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD420747
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: