Provider Demographics
NPI:1306848270
Name:MONTAG, THOMAS W (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:MONTAG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 WIMBLEDON SQ
Mailing Address - Street 2:SUITE F
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4945
Mailing Address - Country:US
Mailing Address - Phone:757-436-9898
Mailing Address - Fax:757-436-5455
Practice Address - Street 1:109 WIMBLEDON SQ
Practice Address - Street 2:SUITE F
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4945
Practice Address - Country:US
Practice Address - Phone:757-436-9898
Practice Address - Fax:757-436-5455
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101059160207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1075087OtherMAMSI (GYN)
VA00X210T01OtherMEDICARE
1231740OtherFIRST HEALTH
21941OtherSENTARA
3600719OtherUNITED HEALTHCARE
463796OtherANTHEM
1175087OtherMAMSI (ONC)
2998639OtherCIGNA
4232842OtherAETNA
VA621780-0Medicaid
P00065884OtherRAILROAD MEDICARE
3600719OtherUNITED HEALTHCARE