Healthcare Provider Details

I. General information

NPI: 1831533520
Provider Name (Legal Business Name): ALICIA MONTGOMERY DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2013
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 ARLINGTON BLVD
FAIRFAX VA
22031-4604
US

IV. Provider business mailing address

21 14TH ST NE
WASHINGTON DC
20002-8419
US

V. Phone/Fax

Practice location:
  • Phone: 703-752-9100
  • Fax: 703-752-9202
Mailing address:
  • Phone: 202-689-9617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number0301202471
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: