Provider Demographics
NPI:1396042941
Name:MONTGOMERY ENDOCRINOLOGY LLC
Entity Type:Organization
Organization Name:MONTGOMERY ENDOCRINOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:MONIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-251-0662
Mailing Address - Street 1:PO BOX 60528
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20859-0528
Mailing Address - Country:US
Mailing Address - Phone:301-251-0662
Mailing Address - Fax:301-251-7703
Practice Address - Street 1:50 W EDMONSTON DR STE 600
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1254
Practice Address - Country:US
Practice Address - Phone:301-251-0662
Practice Address - Fax:301-251-7703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0059510207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty