Provider Demographics
NPI:1427054113
Name:MONTGOMERY, GREGORY F
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:F
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1430
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22803-1430
Mailing Address - Country:US
Mailing Address - Phone:540-564-7036
Mailing Address - Fax:540-564-7171
Practice Address - Street 1:2006 HEALTH CAMPUS DR
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-8679
Practice Address - Country:US
Practice Address - Phone:540-689-5800
Practice Address - Fax:540-689-5801
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010385212086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0128741000OtherWV MEDICAID
VA1427054113Medicaid
VA1000870001OtherDME PROVIDER
VA5266237OtherCIGNA
VA762076OtherSOUTHERN HEALTH
VA345911OtherANTHEM
VA345911OtherANTHEM
VA1427054113Medicaid