MEDICARE: KYLE DAVID 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	MD064400L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080164274	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	30036753	OTHER	PA	KEYSTONE MERCY HEALTH PLA
3	2319021	OTHER	PA	AETNA HMO
4	6052	OTHER	PA	BRAVO HEALTH
5	2Y7472	OTHER	PA	HEALTH NET
6	028886	OTHER	PA	HIGHMARK BLUE SHIELD
7	497977	OTHER	PA	COVENTRY HEALTH AMERICA
8	30036754	OTHER	PA	KEYSTONE MERCY HEALTH PLA
9	5466743	OTHER	PA	AETNA PPO
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	1458249	OTHER	PA	AETNA HMO

General Provider Information

NPI Number	:	1679559223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE DAVID MONTGOMERY MD

Provider Business Mailing Address
First Line	:	PO BOX 820933
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19182-0933
Country	:	US
Telephone Number	:	215-926-3115
Fax Number	:	215-926-3100

Provider Business Practice Location Address
First Line	:	2317 E WESTMORELAND ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19134-4529
Country	:	US
Telephone Number	:	215-926-3115
Fax Number	:	215-926-3100

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

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	01/13/2014

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Directions to “ KYLE DAVID MONTGOMERY MD” Practice Location

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