Provider Demographics
NPI:1083774244
Name:L&M MEDICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:L&M MEDICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-698-9440
Mailing Address - Street 1:9551 BUSTLETON AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-3800
Mailing Address - Country:US
Mailing Address - Phone:215-698-9440
Mailing Address - Fax:215-464-1808
Practice Address - Street 1:9551 BUSTLETON AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-3800
Practice Address - Country:US
Practice Address - Phone:215-698-9440
Practice Address - Fax:215-464-1808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA056868Medicare ID - Type Unspecified