MEDICARE: JONATHAN C MONTAGUE

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	347E00000X	Transportation Broker

General Provider Information

NPI Number	:	1376171645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN C MONTAGUE

Provider Business Mailing Address
First Line	:	1828 LONG MILL RD
Second Line	:
City	:	YOUNGSVILLE
State	:	NC
Zip	:	27596-9178
Country	:	US
Telephone Number	:	919-728-0195
Fax Number	:	215-344-5087

Provider Business Practice Location Address
First Line	:	1828 LONG MILL RD
Second Line	:
City	:	YOUNGSVILLE
State	:	NC
Zip	:	27596-9178
Country	:	US
Telephone Number	:	919-728-0195
Fax Number	:	215-344-5087

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

Provider Enumeration Date	:	03/31/2020
Last Update Date	:	04/13/2020

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Directions to “ JONATHAN C MONTAGUE ” Practice Location

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