=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427054113
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GREGORY F MONTGOMERY
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2005
-----------------------------------------------------
Last Update Date | 11/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2006 HEALTH CAMPUS DR
-----------------------------------------------------
City | HARRISONBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22801-8679
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-689-5800
-----------------------------------------------------
Fax | 540-689-5801
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1430
-----------------------------------------------------
City | HARRISONBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22803-1430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-564-7036
-----------------------------------------------------
Fax | 540-564-7171
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0129X
-----------------------------------------------------
Taxonomy Name | Vascular Surgery Physician
-----------------------------------------------------
License Number | 0101038521
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------