Provider Demographics
NPI:1528338027
Name:MONTGOMERY, SAMANTHA MASTERS (MS, RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:MASTERS
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4007 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2520
Mailing Address - Country:US
Mailing Address - Phone:724-941-7220
Mailing Address - Fax:
Practice Address - Street 1:4007 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2520
Practice Address - Country:US
Practice Address - Phone:724-941-7220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-31
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004761133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered