Basic Information
| Provider Information | |||||||||
| NPI: | 1043312747 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MONTGOMERY | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | A.P. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3110 MACCORKLE AVE SE | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253041210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043471300 | ||||||||
| FaxNumber: | 3043471397 | ||||||||
| Practice Location | |||||||||
| Address1: | 3110 MACCORKLE AVE SE | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253041210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043471300 | ||||||||
| FaxNumber: | 3043471397 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2006 | ||||||||
| LastUpdateDate: | 04/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 19240 | WV | N | Allopathic & Osteopathic Physicians | Family Medicine | 207V00000X | 19240 | WV | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0047960000 | 05 | WV | MEDICAID |