MEDICARE: DR. EMILY A.P. MONTGOMERY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	19240	WV
2	207V00000X	Obstetrics & Gynecology Physician	19240	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043312747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMILY A.P. MONTGOMERY M.D.

Provider Business Mailing Address
First Line	:	3110 MACCORKLE AVE SE
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25304-1210
Country	:	US
Telephone Number	:	304-347-1300
Fax Number	:	304-347-1397

Provider Business Practice Location Address
First Line	:	3110 MACCORKLE AVE SE
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25304-1210
Country	:	US
Telephone Number	:	304-347-1300
Fax Number	:	304-347-1397

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	04/06/2022

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