Provider Demographics
NPI:1114161114
Name:MONTGOMERY, CONNIE MARIE CHEN (MD)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:MARIE CHEN
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:MARIE
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:812 RIGEL LN
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-2767
Mailing Address - Country:US
Mailing Address - Phone:909-224-6336
Mailing Address - Fax:
Practice Address - Street 1:812 RIGEL LN
Practice Address - Street 2:
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-2767
Practice Address - Country:US
Practice Address - Phone:909-224-6336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1136992085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology