Provider Demographics
NPI:1891065199
Name:MONTGOMERY ANESTHESIA, PA
Entity type:Organization
Organization Name:MONTGOMERY ANESTHESIA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:DOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-942-3887
Mailing Address - Street 1:PO BOX 10510
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11555-0510
Mailing Address - Country:US
Mailing Address - Phone:301-838-0437
Mailing Address - Fax:240-342-2810
Practice Address - Street 1:12012 VEIRS MILL RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-4513
Practice Address - Country:US
Practice Address - Phone:301-942-3887
Practice Address - Fax:240-342-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC239774Medicare PIN