Provider Demographics
NPI:1760478358
Name:MONTGOMERY, REBECCA PILES (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:PILES
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4329
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-4329
Mailing Address - Country:US
Mailing Address - Phone:704-892-5454
Mailing Address - Fax:704-892-5858
Practice Address - Street 1:104 KNOX CT STE 100
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-0590
Practice Address - Country:US
Practice Address - Phone:704-892-5454
Practice Address - Fax:704-892-5858
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600646207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891010LMedicaid
E75239Medicare UPIN
NC891010LMedicaid