MEDICARE: PATRICIA A 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	207Q00000X	Family Medicine Physician	MD024066E	PA

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	:	1548292873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA A MONTGOMERY MD

Provider Business Mailing Address
First Line	:	412 CREAMERY WAY
Second Line	:	SUITE 400
City	:	EXTON
State	:	PA
Zip	:	19341-2551
Country	:	US
Telephone Number	:	610-594-7590
Fax Number	:	610-594-7597

Provider Business Practice Location Address
First Line	:	4667 W CHESTER PIKE
Second Line	:
City	:	NEWTOWN SQUARE
State	:	PA
Zip	:	19073-2227
Country	:	US
Telephone Number	:	610-356-7870
Fax Number	:	610-594-2625

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	07/06/2017

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