Provider Demographics
NPI:1578941969
Name:MONTGOMERY, JOHN RICHARD (MD, MSC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RICHARD
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:MD, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 E 33RD ST APT 16J
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-9481
Mailing Address - Country:US
Mailing Address - Phone:843-247-5087
Mailing Address - Fax:
Practice Address - Street 1:403 E 34TH ST FL 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4907
Practice Address - Country:US
Practice Address - Phone:212-263-0243
Practice Address - Fax:212-263-3863
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-18
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301107048390200000X
NY316570204F00000X
NY316570-01208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208600000XAllopathic & Osteopathic PhysiciansSurgery