Provider Demographics
NPI:1457582835
Name:MONTGOMERY ENDOSCOPY CENTER
Entity Type:Organization
Organization Name:MONTGOMERY ENDOSCOPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-942-3550
Mailing Address - Street 1:12012 VEIRS MILL RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-4513
Mailing Address - Country:US
Mailing Address - Phone:301-942-3550
Mailing Address - Fax:301-933-3621
Practice Address - Street 1:12012 VEIRS MILL RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-4513
Practice Address - Country:US
Practice Address - Phone:301-942-3550
Practice Address - Fax:301-933-3621
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTGOMERY GASTROENTEROLOGY PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1024261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC305265Medicare PIN