Provider Demographics
NPI:1639193907
Name:THOMAS W MONTAG MD PLC
Entity Type:Organization
Organization Name:THOMAS W MONTAG MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER GYN ONCOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:MONTAG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-436-9898
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101059160OtherMEDICAL LICENSE
VA621780-0Medicaid
VAC09977OtherMEDICARE GROUP NUMBER
D24867Medicare UPIN