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General NPI Number Information
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NPI Number | 1083762819
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Entity Type | Organization
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Legal Business Name | STEFAN MONTGOMERY MD FAMILY & SPORTS MEDICINE, PA
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 09/08/2008
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Provider Practice Location Address
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Address Line | 2850 PELHAM CT
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City | ORANGEBURG
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State | SC
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Zip | 29118-1400
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Country | US
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Telephone | 803-531-8500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1785
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City | ORANGEBURG
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State | SC
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Zip | 29116-1785
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Country | US
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Telephone | 803-395-4499
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Fax | 803-395-4480
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Authorized Official
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Title or Position | OWNER
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Name | STEFAN L MONTGOMERY
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Credential | MD
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Telephone | 803-531-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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