MEDICARE: MONTGOMERY GASTROENTEROLOGY PA

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	207RG0100X	Gastroenterology Physician

General Provider Information

NPI Number	:	1124024682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTGOMERY GASTROENTEROLOGY PA

Provider Business Mailing Address
First Line	:	12012 VEIRS MILL RD
Second Line	:
City	:	WHEATON
State	:	MD
Zip	:	20906-4513
Country	:	US
Telephone Number	:	301-942-3550
Fax Number	:	301-933-3621

Provider Business Practice Location Address
First Line	:	12012 VEIRS MILL RD
Second Line	:
City	:	WHEATON
State	:	MD
Zip	:	20906-4513
Country	:	US
Telephone Number	:	301-942-3550
Fax Number	:	301-933-3621

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAVID B DOMAN
Credential	:	M.D.
Telephone Number	:	301-942-3550

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	02/04/2011

Similar Medicare Providers

1700889631 — DAVID B DOMAN MD
Practice Location Address:

12012 VEIRS MILL RD
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20906-4513

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1184622631 — BARRY I HECHT M.D.
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1558316752 — MONTGOMERY RENAL ASSOCIATES P.A.
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1316950066 — DR. PETER BRUCE SHERER MD
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