MEDICARE: MONTGOMERY PHYSICIAN ASSOCIATES PC

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	207R00000X	Internal Medicine Physician	D0031720	MD
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	D0031720	MD
3	207R00000X	Internal Medicine Physician	D0040860	MD

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	:	1801989942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTGOMERY PHYSICIAN ASSOCIATES PC

Provider Business Mailing Address
First Line	:	19241 MONTGOMERY VILLAGE AVENUE
Second Line	:	STE E23
City	:	MONTGOMERY VILLAGE
State	:	MD
Zip	:	20886-5036
Country	:	US
Telephone Number	:	301-948-0098
Fax Number	:	301-926-9180

Provider Business Practice Location Address
First Line	:	19241 MONTGOMERY VILLAGE AVENUE
Second Line	:	STE E23
City	:	MONTGOMERY VILLAGE
State	:	MD
Zip	:	20886-5036
Country	:	US
Telephone Number	:	301-948-0098
Fax Number	:	301-926-9180

Authorized Official
Title or Position	:	PRESIDENT PHYSICIAN
Name	:	DR. ANOMA BANDARA
Credential	:	MD
Telephone Number	:	301-948-0098

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	09/02/2010

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