Provider Demographics
NPI:1386089183
Name:MONTGOMERY MEDICAL SERVICES
Entity type:Organization
Organization Name:MONTGOMERY MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO AND FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ANUSHIRAVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DADGAR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:301-343-6505
Mailing Address - Street 1:10110 MOLECULAR DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-7539
Mailing Address - Country:US
Mailing Address - Phone:301-279-2779
Mailing Address - Fax:240-403-0190
Practice Address - Street 1:10110 MOLECULAR DR
Practice Address - Street 2:SUITE 206
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-7539
Practice Address - Country:US
Practice Address - Phone:301-279-2779
Practice Address - Fax:240-403-0190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0051280207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty