Provider Demographics
NPI:1528181591
Name:MONTGOMERY COLORECTAL SURGERY LLC
Entity type:Organization
Organization Name:MONTGOMERY COLORECTAL SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-403-0415
Mailing Address - Street 1:9715 MEDICAL CENTER DR STE 233
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6302
Mailing Address - Country:US
Mailing Address - Phone:240-403-0415
Mailing Address - Fax:240-403-0417
Practice Address - Street 1:9715 MEDICAL CENTER DR STE 233
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6302
Practice Address - Country:US
Practice Address - Phone:240-403-0415
Practice Address - Fax:240-403-0417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD59199208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG02469Medicare PIN