Provider Demographics
NPI:1588017834
Name:MONTGOMERY GYNECOLOGY LLC
Entity Type:Organization
Organization Name:MONTGOMERY GYNECOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONNALAGADDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-444-3411
Mailing Address - Street 1:115 PLYMOUTH RD
Mailing Address - Street 2:#C5
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1407
Mailing Address - Country:US
Mailing Address - Phone:215-444-3411
Mailing Address - Fax:
Practice Address - Street 1:115 PLYMOUTH RD
Practice Address - Street 2:#C5
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1407
Practice Address - Country:US
Practice Address - Phone:215-444-3411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty