Basic Information
| Provider Information | |||||||||
| NPI: | 1891065199 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MONTGOMERY ANESTHESIA, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 10510 | ||||||||
| Address2: | |||||||||
| City: | UNIONDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115550510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018380437 | ||||||||
| FaxNumber: | 2403422810 | ||||||||
| Practice Location | |||||||||
| Address1: | 12012 VEIRS MILL RD | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209064513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019423887 | ||||||||
| FaxNumber: | 2403422801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2012 | ||||||||
| LastUpdateDate: | 07/09/2015 | ||||||||
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| AuthorizedOfficialLastName: | DOMAN | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3019423887 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.