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1104319284

NPI Code Detail

MEDICARE: ERICA LYNN MONTGOMERY MD

MEDICARE: ERICA LYNN MONTGOMERY MD

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	208100000X	Physical Medicine & Rehabilitation Physician	MT215421	PA
2	208100000X	Physical Medicine & Rehabilitation Physician	35C.003623	OH
3	207R00000X	Internal Medicine Physician	MT215421	PA

General Provider Information

NPI Number	:	1104319284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA LYNN MONTGOMERY MD

Provider Business Mailing Address
First Line	:	3401 N BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-5103
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 N BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-5103
Country	:	US
Telephone Number	:	215-707-2000
Fax Number	:

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

Provider Enumeration Date	:	06/12/2018
Last Update Date	:	01/19/2026

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Directions to “ ERICA LYNN MONTGOMERY MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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