Provider Demographics
NPI:1073507117
Name:MONTGOMERY OTOLARYNGOLOGY CONSULTANTS
Entity Type:Organization
Organization Name:MONTGOMERY OTOLARYNGOLOGY CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENT PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:IRA
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-963-6334
Mailing Address - Street 1:19211 MONTGOMERY VILLAGE AVE
Mailing Address - Street 2:#B-23
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20886-5028
Mailing Address - Country:US
Mailing Address - Phone:301-963-6334
Mailing Address - Fax:301-869-7204
Practice Address - Street 1:19211 MONTGOMERY VILLAGE AVE
Practice Address - Street 2:#B-23
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20886-5028
Practice Address - Country:US
Practice Address - Phone:301-963-6334
Practice Address - Fax:301-869-7204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD179102Medicare PIN