Basic Information
| Provider Information | |||||||||
| NPI: | 1972604023 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MONTGOMERY FAMILY MEDICINE ASSOCIATES PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MONTGOMERY FAMILY MEDICINE ASSOCIATES,PC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2415 MUSGROVE RD | ||||||||
| Address2: | #105 | ||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209045200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019890193 | ||||||||
| FaxNumber: | 3018792325 | ||||||||
| Practice Location | |||||||||
| Address1: | 2415 MUSGROVE RD | ||||||||
| Address2: | #105 | ||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209045200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019890193 | ||||||||
| FaxNumber: | 3018792325 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 03/27/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| AuthorizedOfficialLastName: | SINGH | ||||||||
| AuthorizedOfficialFirstName: | ROSIE | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3019890193 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 03/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.