Provider Demographics
NPI:1972604023
Name:MONTGOMERY FAMILY MEDICINE ASSOCIATES PC
Entity type:Organization
Organization Name:MONTGOMERY FAMILY MEDICINE ASSOCIATES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-989-0193
Mailing Address - Street 1:2415 MUSGROVE RD
Mailing Address - Street 2:#105
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-5200
Mailing Address - Country:US
Mailing Address - Phone:301-989-0193
Mailing Address - Fax:301-879-2325
Practice Address - Street 1:2415 MUSGROVE RD
Practice Address - Street 2:#105
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-5200
Practice Address - Country:US
Practice Address - Phone:301-989-0193
Practice Address - Fax:301-879-2325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD=========OtherTAX ID