Provider Demographics
NPI:1730208158
Name:MONTGOMERY, LYLE B (MD)
Entity type:Individual
Prefix:DR
First Name:LYLE
Middle Name:B
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:LYLE
Other - Middle Name:A
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:109 FORD ST
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-1419
Mailing Address - Country:US
Mailing Address - Phone:315-394-0101
Mailing Address - Fax:
Practice Address - Street 1:109 FORD ST
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-1419
Practice Address - Country:US
Practice Address - Phone:315-394-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS210532084P0800X
TXH64462084P0800X
LA3080052084P0800X
NY1892262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC5260Medicare PIN