Healthcare Provider Details

I. General information

NPI: 1366553166
Provider Name (Legal Business Name): MICHAEL T MONTGOMERY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MADISON ST
HINTON WV
25951-2543
US

IV. Provider business mailing address

301 MADISON ST
HINTON WV
25951-2543
US

V. Phone/Fax

Practice location:
  • Phone: 304-466-2501
  • Fax: 304-466-2513
Mailing address:
  • Phone: 304-466-2501
  • Fax: 304-466-2513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1486
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: