MEDICARE: ELIZABETH LINDSAY MONTAGUE-FARWELL D.O.

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	207V00000X	Obstetrics & Gynecology Physician	LL37670	SC
2	207V00000X	Obstetrics & Gynecology Physician	2019-01682	NC

General Provider Information

NPI Number	:	1043690480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH LINDSAY MONTAGUE-FARWELL D.O.

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1450 MATTHEWS TOWNSHIP PKWY STE 300
Second Line	:
City	:	MATTHEWS
State	:	NC
Zip	:	28105-5332
Country	:	US
Telephone Number	:	704-321-1077
Fax Number	:	704-321-1086

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

Provider Enumeration Date	:	06/01/2015
Last Update Date	:	07/25/2023

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