Provider Demographics
NPI:1346492238
Name:MONTGOMERY, VICENTA MARIA I (PA)
Entity Type:Individual
Prefix:MRS
First Name:VICENTA
Middle Name:MARIA
Last Name:MONTGOMERY
Suffix:I
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:VICENTA
Other - Middle Name:MARIA
Other - Last Name:BIRTHRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1600 ROCKLAND ROAD
Mailing Address - Street 2:DEPARTMENT OF NEUROLOGY
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19899
Mailing Address - Country:US
Mailing Address - Phone:302-651-5930
Mailing Address - Fax:302-651-5967
Practice Address - Street 1:1 COLUMBIA ST
Practice Address - Street 2:DRA IMAGING, PC
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3923
Practice Address - Country:US
Practice Address - Phone:845-454-4700
Practice Address - Fax:845-790-5719
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE363AM0700X
FLPA9104769363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical