Basic Information
| Provider Information | |||||||||
| NPI: | 1104215581 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MONTGOMERY GENERAL HOSPITAL INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18101 PRINCE PHILIP DR | ||||||||
| Address2: | |||||||||
| City: | OLNEY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208321514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017748882 | ||||||||
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| Address1: | 18101 PRINCE PHILIP DR | ||||||||
| Address2: | |||||||||
| City: | OLNEY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208321514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017748882 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2015 | ||||||||
| LastUpdateDate: | 01/22/2015 | ||||||||
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| AuthorizedOfficialLastName: | HAVRILLA | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT/CFO | ||||||||
| AuthorizedOfficialTelephone: | 3017748770 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.