Provider Demographics
NPI:1164013256
Name:THE MONTGOMERY MEDICAL CLINIC
Entity Type:Organization
Organization Name:THE MONTGOMERY MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHADWELL
Authorized Official - Suffix:
Authorized Official - Credentials:CFNP
Authorized Official - Phone:703-351-5100
Mailing Address - Street 1:3800 FAIRFAX DR STE 2
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1703
Mailing Address - Country:US
Mailing Address - Phone:703-351-5100
Mailing Address - Fax:703-351-1445
Practice Address - Street 1:3800 FAIRFAX DR STE 2
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1703
Practice Address - Country:US
Practice Address - Phone:703-351-5100
Practice Address - Fax:703-351-1445
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTGOMERY MEDICAL CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty