Provider Demographics
NPI:1194725739
Name:CORNERSTONE MONTGOMERY, INC.
Entity type:Organization
Organization Name:CORNERSTONE MONTGOMERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-493-4200
Mailing Address - Street 1:6040 SOUTHPORT DR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-1848
Mailing Address - Country:US
Mailing Address - Phone:301-493-4200
Mailing Address - Fax:301-493-6209
Practice Address - Street 1:6040 SOUTHPORT DR
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1848
Practice Address - Country:US
Practice Address - Phone:301-493-4200
Practice Address - Fax:301-493-6209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAWST000010OtherVALUEOPTIONS
MD837ASTOtherBLUE CROSS BLUE SHIELD
MD2525020-00Medicaid
MD001826Medicare ID - Type Unspecified